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Vafai-Tabrizi F, Schwab U, Brecht S, Funk GC. Adjustments to maintenance therapy and the reasoning behind them among COPD outpatients in Austria: the STEP study. ERJ Open Res 2024; 10:00615-2023. [PMID: 38333644 PMCID: PMC10851946 DOI: 10.1183/23120541.00615-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/08/2023] [Indexed: 02/10/2024] Open
Abstract
Background Adjustments to COPD maintenance treatment are based on different guidelines. In Austria, there is a lack of real-world data on treatment adjustments of COPD outpatients and their underlying rationale. The STEP study characterised change patterns of pharmacological maintenance therapy in COPD outpatients in predefined categories of step-up, step-down and switch, the underlying reasons, and predictors in clinical routine in Austria. Methods STEP was a single-visit non-interventional study in Austria. 77 pulmonologists based in outpatient clinics documented previous and adapted COPD therapy, reason for change, patient characteristics, COPD phenotype, and lung function. Patients' COPD symptom burden was assessed by using the COPD Assessment Test (CAT). Predictors for therapy changes were identified. Results 1137 patients were studied (mean±sd age 67±10 years; 56.9% male; mean forced expiratory volume in 1 s 56.3% predicted; Global Initiative for Chronic Obstructive Lung Disease B and E stages 66% and 19%, respectively; mean CAT score 17.5). Therapy step-up was observed in 59.3%, treatment switch in 21.7% and step-down in 19.0% of patients. Triple therapy comprised the biggest proportion of inhalation treatment (53.3%). Physicians reported lung function, symptom burden and exacerbations as the main reasons for step-up or step-down, whereas switches within the same treatment class were predominantly caused by device issues. Predictors for step-up were comorbid asthma and exacerbations among others. Conclusions STEP was the first study to investigate COPD therapy changes in clinical routine in Austria. The most frequent treatment adjustment was step-up, followed by treatment switch and step-down. Symptom burden, stable or improved lung function and inhalation device handling were the most frequently given reasons for adjustments.
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Affiliation(s)
- Florian Vafai-Tabrizi
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and 2nd Medical Department with Pneumology, Klinik Ottakring, Vienna, Austria
| | | | | | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and 2nd Medical Department with Pneumology, Klinik Ottakring, Vienna, Austria
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2
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Pham KH, Tran NTC, Tran HD, Ngo TH, Tran VD, Ly HHV, Pham NTN, Nguyen T, Nguyen BH, Nguyen KT. Single Nucleotide Polymorphisms of FAM13A Gene in Chronic Obstructive Pulmonary Disease-A Case Control Study in Vietnam. Adv Respir Med 2023; 91:268-277. [PMID: 37366807 DOI: 10.3390/arm91030021] [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: 04/20/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND In 2018, GOLD addressed the issues of genotypes associated with risk factors for COPD. The genome-wide association study (GWAS) demonstrated an association between COPD and several genetic variants of single nucleotide polymorphisms (SNPs) of the FAM13A gene with the risk of COPD. OBJECTIVE To study the single nucleotide polymorphisms rs2869967 and rs17014601 of the FAM13A gene in chronic obstructive pulmonary disease. Subjects and research methods: 80 subjects diagnosed with COPD and 80 subjects determined not to have COPD according to GOLD 2020 criteria; the subjects were clinically examined, interviewed, and identified as possessing single nucleotide polymorphisms using the sanger sequencing method on whole blood samples. RESULTS The male/female ratio of the patient group and the control group was 79/1 and 39/1, respectively. The percentages of C and T alleles of rs2869967 in COPD patients were 50.6% and 49.4%, respectively. The percentages of C and T alleles of rs17014601 in COPD patients were 31.9% and 68.1%, respectively. At rs17014601, the ratio values of alleles T and C in the disease group and the control group were markedly different, making them statistically reliable (p = 0.031). The rate of CT genotype in the group of patients was considerably higher than that of the control group. The TT homozygous genotype had a lower risk of COPD compared with the other genotypes in the dominant model (ORTT/(CC + CT) = 0.441; CI95% = 0.233-0.833); this difference was statistically significant (p = 0.012). CONCLUSIONS With rs17014601, it is characteristic that the frequency of the T allele appears more than the C allele, and the CT heterozygous phenotype accounts for the highest proportion in rs17014601 and rs2869967 recorded in COPD patients. There is an association between the genetic variant of the SNP FAM13A-rs17014601 and the risk of COPD.
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Affiliation(s)
- Khanh Hoang Pham
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Nhung Thi Cam Tran
- Department of Anesthesiology and Resuscitation, Hoan My Cuu Long Hospital, Can Tho City 900000, Vietnam
| | - Hung Do Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Toan Hoang Ngo
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Van De Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Hung Huynh Vinh Ly
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Nga Thi Ngoc Pham
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Thang Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Binh Huy Nguyen
- Physiology Department, Hanoi Medical University, Ha Noi 100000, Vietnam
| | - Kien Trung Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
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3
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Somayaji R, Chalmers JD. Just breathe: a review of sex and gender in chronic lung disease. Eur Respir Rev 2022; 31:31/163/210111. [PMID: 35022256 DOI: 10.1183/16000617.0111-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic lung diseases are the third leading cause of death worldwide and are increasing in prevalence over time. Although much of our traditional understanding of health and disease is derived from study of the male of the species - be it animal or human - there is increasing evidence that sex and gender contribute to differences in disease risk, prevalence, presentation, severity, treatment approach, response and outcomes. Chronic obstructive pulmonary disease, asthma and bronchiectasis represent the most prevalent and studied chronic lung diseases and have key sex- and gender-based differences which are critical to consider and incorporate into clinical and research approaches. Mechanistic differences present opportunities for therapeutic development whereas behavioural and clinical differences on the part of patients and providers present opportunities for greater education and understanding at multiple levels. In this review, we seek to summarise the sex- and gender-based differences in key chronic lung diseases and outline the clinical and research implications for stakeholders.
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Affiliation(s)
- Ranjani Somayaji
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada .,Dept of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Canada.,Dept of Community Health Sciences, University of Calgary, Calgary, Canada
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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4
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Al-Moamary MS, Köktūrk N, Idrees MM, Şen E, Juvelekian G, Saleh WA, Zoumot Z, Behbehani N, Hatem A, Masoud HH, Snouber A, van Zyl-Smit RN. Unmet need in the management of chronic obstructive pulmonary disease in the Middle East and Africa region: An expert panel consensus. Respir Med 2021; 189:106641. [PMID: 34649155 DOI: 10.1016/j.rmed.2021.106641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has a significant impact on healthcare systems and health-related quality of life. Increased prevalence of smoking is an important factor contributing to high burden of COPD in the Middle East and Africa (MEA). Several other factors including sedentary lifestyle, urbanization, second-hand smoke, air pollution, and occupational exposure are also responsible for the upsurge of COPD in the MEA. Frequent COPD exacerbations accelerate disease progression, progressively deteriorate the lung function, and negatively affect quality of life. This consensus is based on review of the published evidence, international and regional guidelines, and insights provided by the expert committee members from the MEA region. Spirometry, though the gold standard for diagnosis, is often unavailable and/or underutilized leading to underdiagnosis of COPD in primary care settings. Low adherence to the treatment guidelines and delayed use of appropriate combination therapy including triple therapy are additional barriers in management of COPD in MEA. It is necessary to recognize COPD as a screenable condition and develop easy and simple screening tools to facilitate early diagnosis. Knowledge of the disease symptomatology at patient and physician level and adherence to the international or regional guidelines are important to create awareness about harmful effects of smoking and develop national guidelines to focus on prevention on COPD. Implementation of vaccination program and pulmonary rehabilitation are equally valuable to manage patients with COPD at local and regional level. We present recommendations made by the expert panel for improved screening, diagnosis, and management of COPD in MEA.
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Affiliation(s)
- Mohamed S Al-Moamary
- Department of Medicine, College of Medicine, King Saudi Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Nurdan Köktūrk
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Majdy M Idrees
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elif Şen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - George Juvelekian
- Department of Pulmonary and Critical Care Medicine, Saint George Hospital University Medical Centre, Beirut, Lebanon
| | | | - Zaid Zoumot
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ashraf Hatem
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hosam H Masoud
- Department of Chest Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Richard N van Zyl-Smit
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
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5
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Egervall K, Rosso A, Elmståhl S. Association between cardiovascular disease- and inflammation-related serum biomarkers and poor lung function in elderly. Clin Proteomics 2021; 18:23. [PMID: 34583636 PMCID: PMC8480099 DOI: 10.1186/s12014-021-09329-7] [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: 06/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and reduced lung function is an important risk factor for CVD and CVD-related death. However, the mechanisms behind the increased risk for CVD in COPD patients are not fully understood. Methods We examined the association between CVD- and inflammation-related serum biomarkers, and pulmonary function in a geriatric population. 266 biomarkers related to CVD and inflammation were analyzed in blood samples from 611 subjects aged 66–86 years who participated in the Good Aging in Skåne study. Serum levels were assessed by a proximity extension assay. Pulmonary function was measured using the lower limit of normality (LLN) spirometry criteria, i.e., forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < LLN. Logistic regression models were implemented and multiple comparisons were accounted for. Results 10.3% of the study participants fulfilled pulmonary function decline criteria according to LLN. Out of the 266 biomarkers, only plasminogen activator, urokinase receptor (PLAUR) was statistically significantly associated with decreased pulmonary function. We could not find a statistically significant association between pulmonary function decline and other biomarkers previously linked to COPD, such as interleukin 6, tumor necrosis factor and surfactant protein D. Conclusion We found that serum levels of PLAUR are associated with pulmonary function decline in older adults. PLAUR is activated following inflammation and promotes matrix metallopeptidase (MMP) activation and extracellular matrix (ECM) degradation. This implies that PLAUR could play a role in the early phase of COPD pathogenesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12014-021-09329-7.
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Affiliation(s)
- K Egervall
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
| | - A Rosso
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - S Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
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6
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Boehm A, Aichner M, Sonnweber T, Tancevski I, Fischer T, Sahanic S, Joannidis M, Weiss G, Pizzini A, Loeffler-Ragg J. COPD exacerbations are related to poor air quality in Innsbruck: A retrospective pilot study. Heart Lung 2021; 50:499-503. [PMID: 33836440 DOI: 10.1016/j.hrtlng.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Triggers of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are diverse, potentially including airborne pollutants. OBJECTIVES To analyze whether daily air pollution levels correlate with AECOPD frequency. METHODS In this retrospective pilot-study, AECOPD frequency was recorded between 2010 and 2016 at the University Hospital of Innsbruck's emergency department and correlated with daily air quality parameters. Data was compared to pulmonary embolism (PE) frequency, a disease not directly involving the airways. RESULTS In total, 669 AECOPD and 857 PE events were registered. Days with AECOPD revealed significantly higher concentrations of CO and SO2, whereas days with PE displayed an elevation of NO. Higher frequencies of AECOPD during winter months correlated with higher CO and SO2 levels, disclosing a seasonal trend, while no such pattern was observed for PE. CONCLUSION Air pollution is linked to AECOPD frequency, however, prospective studies are needed to confirm this possible, underrecognized trigger of AECOPD.
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Affiliation(s)
- Anna Boehm
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Magdalena Aichner
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Thomas Sonnweber
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Ivan Tancevski
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Thomas Fischer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Sabina Sahanic
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Guenter Weiss
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Alex Pizzini
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Judith Loeffler-Ragg
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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7
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Levin KA, Anderson D, Crighton E. Prevalence of COPD by age, sex, socioeconomic position and smoking status; a cross-sectional study. HEALTH EDUCATION 2020. [DOI: 10.1108/he-06-2020-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to calculate gender and socioeconomic status (SES) inequalities in chronic obstructive pulmonary disease (COPD) in Greater Glasgow and Clyde and measure the proportion of inequalities explained by smoking.Design/methodology/approachMedical records until May 2016 were linked to mortality data to measure COPD prevalence. Population estimates for smoking status were calculated by merging three (2013–2015) Scottish Household Survey rounds. Poisson regression was carried out to analyse the relationship between SES and gender inequalities in COPD, and smoking.FindingsCrude COPD prevalence for ages 16+ years was 3.29% and for ages 45 years+ was 6.26%, and higher in females than males. Adjusting for age and sex, prevalence of COPD in the most deprived quintile was 4.5 times of that in the least deprived. Adjustment for smoking explains almost half of the relative difference between Scottish Indicator for Multiple Deprivation (SIMD) 1 (least affluent quintile of deprivation) and SIMD 5 (most affluent quintile) and a fifth of the absolute difference. There is a higher risk of COPD among male non-smokers than female, but among smokers the risk is greater for females than males.Research limitations/implicationsRisk factors specific to respiratory health beyond smoking and common risk factors of morbidity more generally should be considered in understanding inequalities in COPD.Originality/valuePrevalence of COPD is higher than previously thought. Smoking explains less than half of inequalities in COPD. Gender inequalities in COPD are dependent on smoking status and the smoking indicator used.
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8
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Sumit AF, Das A, Miraj IH, Bhowmick D. Association between chronic obstructive pulmonary disease (COPD) and occupational exposures: A hospital based quantitative cross-sectional study among the Bangladeshi population. PLoS One 2020; 15:e0239602. [PMID: 32966342 PMCID: PMC7510960 DOI: 10.1371/journal.pone.0239602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022] Open
Abstract
The association between chronic obstructive pulmonary disease (COPD) and occupational exposures are less studied in Bangladeshi context, despite the fact that occupational exposures are serious public health concerns in Bangladesh. Therefore, this study aimed to evaluate this association considering demographic, health and smoking characteristics of Bangladeshi population. This was a hospital-based quantitative study including 373 participants who were assessed for COPD through spirometry testing. Assessment of occupational exposures was based on both self-reporting by respondents and ALOHA based job exposure matrix (JEM). Here, among the self-reported exposed group (n = 189), 104 participants (55%) were found with COPD compared to 23 participants (12.5%) in unexposed group (n = 184) that differed significantly (p = 0.00). Similarly, among the JEM measured low (n = 103) and high exposed group (n = 236), 23.3% and 41.5% of the participants were found with COPD respectively; compared to unexposed group (14.7%; n = 34), that differed significantly also (p = 0.00). Likewise, participants with longer self-reported occupational exposures (>8 years) showed significantly (p = 0.00) higher proportions of COPD (79.5%) compared to 40.4% in shorter exposure group (1-8 years). Similarly, significant (p = 0.00) higher cases of COPD were observed among the longer cumulative exposure years (>9 years) group than the shorter cumulative exposure years (1-9 years) group in JEM. While combining smoking and occupational exposure, the chance of developing COPD among the current, former and non-smokers of exposed group were 7.4, 7.2 and 12.7 times higher respectively than unexposed group. Furthermore, logistic analysis revealed that after adjustments for confounding risk factors, the chance of developing COPD among the self-reported exposure group was 6.3 times higher (ORs: 6.3, p = 0.00) than unexposed group; and JEM exposure group has odds of 2.8 and 1.1 respectively (p<0.05) for high and low exposures. Further studies are needed to reinforce this association between COPD and occupational exposure in Bangladesh.
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Affiliation(s)
- Ahmed Faisal Sumit
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
| | - Anindya Das
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | | | - Debasish Bhowmick
- Department of Respiratory Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh
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9
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Cho J, Lee CH, Kim DK, Hwang HG, Kim YI, Choi HS, Park JW, Yoo KH, Jung KS, Lee SD. Impact of gender on chronic obstructive pulmonary disease outcomes: a propensity score-matched analysis of a prospective cohort study. Korean J Intern Med 2020; 35:1154-1163. [PMID: 32098456 PMCID: PMC7487291 DOI: 10.3904/kjim.2019.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/01/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Despite increasing awareness of the burden of chronic obstructive pulmonary disease (COPD) in women, knowledge regarding gender differences in COPD outcomes is limited. Therefore, we aimed to evaluate whether COPD outcomes, including exacerbations, lung function, and symptoms differ by gender. METHODS We recruited patients with COPD from two Korean multicenter prospective cohorts. After propensity score matching, the main outcome, the incidence of moderate or severe exacerbations was analyzed using a negative binomial regression model. We also assessed changes in lung function and symptom scores including the St. George's respiratory questionnaire for COPD (SGRQ-C), COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea score. RESULTS After propensity score matching, 74 women and 74 men with COPD were included. The incidence rates of exacerbations in women and men were not significantly different (incidence rate ratio, 1.49; 95% confidence interval [CI], 0.88 to 2.54). There was no significant difference in the incidence rates adjusted for medication possession ratios of long-acting muscarinic antagonists, long-acting β-agonists, and inhaled corticosteroids during the follow-up period (incidence rate ratio, 1.47; 95% CI, 0.86 to 2.52). Rates of decline in post-bronchodilator forced expiratory volume in 1 second and forced vital capacity did not differ between women and men during 48 months of follow-up. The changes in scores on the SGRQ-C, CAT, and mMRC Questionnaire in women were also similar to those in men. CONCLUSION We observed no gender differences in the rate of exacerbations of COPD in a prospective longitudinal study. Further studies are needed to confirm these findings in the general COPD population.
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Affiliation(s)
- Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Chang-Hoon Lee, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea Tel: +82-2-2072-4743, Fax: +82-2-762-9662, E-mail:
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hun-Gyu Hwang
- Division of Respiratory, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hye Sook Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jeong-Woong Park
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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Xiong H, Huang Q, Shuai T, Zhu L, Zhang C, Zhang M, Wang Y, Liu J. Assessment of comorbidities and prognosis in patients with COPD diagnosed with the fixed ratio and the lower limit of normal: a systematic review and meta-analysis. Respir Res 2020; 21:189. [PMID: 32677946 PMCID: PMC7364614 DOI: 10.1186/s12931-020-01450-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/09/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) is not uniform, COPD guidelines recommend fixed ratio (FR), whereas ATS and ERS define airflow obstruction based on lower limit of normal (LLN). We aim to determine if there is difference between the two diagnostic criteria for morbidity, mortality, exacerbation. METHODS Four databases and all relevant studies from the references were searched from inception to June 25, 2019, to find studies that described the rate of comorbidity, the exacerbation rates, mortality in COPD patients. Data analysis was performed using STATA/SE 14.0 and followed the standard of Cochrane Collaboration. A sensitivity analysis was performed to find the source of heterogeneity. RESULTS Thirteen studies and 154,447 participants were finally included in this meta-analysis. The 11 cohort studies and 2 cross-sectional studies were all high-quality. Patients with airflow limitation according to either FR or LLN had higher mortality (HRFR+/LLN- = 1.27, 95% CI = 1.14-1.42; HRFR-/LLN+ = 1.83, 95% CI = 1.17-2.86) than those who met neither criteria. When compared with the FR-/LLN- criteria, those who met the FR criteria were more likely to exacerbate (HR FR+/LLN- = 1.64, 95% CI = 1.09-2.46; HR FR-/LLN+ = 1.58, 95% CI = 0.70-3.55). The meta-analysis for comorbidities showed no significant difference between patients who met neither criteria and those who met LLN or FR criteria. CONCLUSION The patients with airflow limitations according to FR were more likely to exacerbate than those with LLN only. Patients that met either FR or LLN were more likely to have higher mortality than FR-/LLN-. There was no difference between the FR+/LLN- and FR-/LLN+ groups for the occurrence of comorbidities.
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Affiliation(s)
- Huaiyu Xiong
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Qiangru Huang
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Tiankui Shuai
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Lei Zhu
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Chuchu Zhang
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Meng Zhang
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Yalei Wang
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Jian Liu
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China. .,Department of Intensive Care Unit, The First Hospital of Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China.
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11
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ÖZDEMİR T, YILMAZ DEMİRCİ N, KILIÇ H, KOÇ O, KAYA A, ÖZTÜRK C. An epidemiologic study of physician-diagnosed chronic obstructive pulmonary disease in the Turkish population: COPDTURKEY-1. Turk J Med Sci 2020; 50:132-140. [PMID: 31759382 PMCID: PMC7080360 DOI: 10.3906/sag-1908-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background/aim Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow limitation and respiratory symptoms. It is a leading cause of morbidity and mortality all over the world. Our data on COPD in Turkey are limited. This study was intended to examine the epidemiologic characteristics of COPD in the Turkish population, between 2012 and 2016. Materials and methods This population-based, descriptive, surveillance study examined physician-diagnosed COPD prevalence, incidence, and mortality in Turkey. The database of the Social Security System of Turkey was scanned and ICD-10 J44.0-J44.9 codes for diagnostic and/ or therapeutic purposes were evaluated retrospectively. Results In 2016, there were 3,434,262 cases of COPD (56.2% men) in Turkey, and the mean age of patients was 61.62 ± 14.76 years. From 2012 to 2016, the annual overall prevalence rates of physician-diagnosed COPD rose from 4.3% to 5.8%, which was a 35.0% relative increase (P < 0.05). In women, this rate rose from 3.7% to 5.1% (38% increase), and in men, it rose from 4.9% to 6.7% (37% increase). During the study period, the overall incidence decreased from 8.5 per 1000 adults in 2012 to 6.3 per 1000 adults in 2016, representing a decrease of 26.6% (P < 0.001). The annual incidence rates of physician-diagnosed COPD decreased 25.4% in women and 27.9% in men. The overall mortality was 4.3% in 2012, and 4.2% in 2016. The mortality rate in women was 3.5% in 2012 and 3.7% in 2016, and 5% in 2012 and 4.7% in 2016 in men. The mean prevalence by region was 5.26% (range 3.79%–7.65%). The Black Sea region had the highest COPD prevalence. Conclusion COPD is a very common and serious cause of morbidity and mortality in Turkey, as it is worldwide. Current data will contribute to a better understanding of the epidemiologic dimension of COPD in our country.
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Affiliation(s)
- Tarkan ÖZDEMİR
- Department of Chest Diseases, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Research andTraining Hospital, AnkaraTurkey
| | | | - Hatice KILIÇ
- Department of Chest Diseases, School of Medicine, Yildirim Beyazit University, AnkaraTurkey
| | - Orhan KOÇ
- Department of Management, Social Security Institution, AnkaraTurkey
| | - Akın KAYA
- Department of Chest Diseases, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Can ÖZTÜRK
- Department of Chest Diseases, Faculty of Medicine, Gazi University, AnkaraTurkey
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12
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Huang W, Xie R, Hong Y, Chen Q. Association Between Comorbid Chronic Obstructive Pulmonary Disease and Prognosis of Patients Admitted to the Intensive Care Unit for Non-COPD Reasons: A Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2020; 15:279-287. [PMID: 32103927 PMCID: PMC7012221 DOI: 10.2147/copd.s244020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Aim Chronic obstructive pulmonary disease (COPD) is a rather common comorbid condition among patients admitted to the intensive care unit (ICU), while evidence of how this comorbidity affects prognosis is limited. This study aimed to investigate the associations between COPD comorbidity and prognoses of patients who were admitted to the ICU for non-COPD reasons, and to examine whether the associations varied between different types of ICU. Methods A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥18 years) patients of first ICU admission in the database were enrolled as study participants but those with a primary diagnosis of COPD were excluded. The primary endpoint was 28-day mortality after ICU admission and multivariable Cox regression analyses were employed to assess the associations between COPD comorbidity and the study endpoints. Different adjusting models including a propensity score were used to adjust potential confounders. Results A total of 29,499 patients were enrolled finally, among which 3,332 patients (11.30%) were comorbid with COPD. A higher 28-day mortality was observed among patients with COPD than those without COPD (13.90% versus 8.07%, P<0.001), but there was no statistically significant difference in the proportion of patients who needed mechanical ventilation on the first day after ICU admission between the two groups. Multivariable Cox regression analyses found a significant association between COPD comorbidity and 28-day mortality (adjusted hazard ratio=1.32, 95% confidence interval=1.19-1.47, P<0.0001). The associations were broadly consistent among patients admitted to different types of ICU, but a much higher estimate was observed in patients admitted to cardiac surgery recovery unit (adjusted hazard ratio=2.03, 95% confidence interval=1.44-2.86, P<0.0001). Conclusion Comorbid COPD increased the risk of 28-day mortality among patients admitted to the ICU for non-COPD reasons, especially for those admitted to the cardiac surgery recovery unit.
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Affiliation(s)
- Wencheng Huang
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, People's Republic of China
| | - Ruijie Xie
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yuancheng Hong
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, People's Republic of China
| | - Qingui Chen
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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13
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Choi JY, Kim SY, Lee JH, Park YB, Kim YH, Um SJ, Jung KS, Yoo KH, Park SJ, Yoon HK. Clinical Characteristics of Chronic Obstructive Pulmonary Disease in Female Patients: Findings from a KOCOSS Cohort. Int J Chron Obstruct Pulmon Dis 2020; 15:2217-2224. [PMID: 33061339 PMCID: PMC7519806 DOI: 10.2147/copd.s269579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/28/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The prevalence of chronic obstructive pulmonary disease (COPD) in females has increased, changing the concept of COPD as a disease mostly limited to males. In this study, the clinical characteristics of COPD in females were investigated. PATIENTS AND METHODS The study was based on a multicenter cohort of COPD patients recruited from 54 medical centers in South Korea. Sex-based differences in general characteristics, exposure risk factors, depression scores, results of pulmonary function tests, COPD exacerbation, symptom scores, and radiologic findings were evaluated. Sex-related differences in the annual FEV1 change over 5 years were analyzed in a linear mixed model. RESULTS Of the 2515 patients enrolled in this study, 8.1% were female. Female patients who had a higher BMI and a lower level of education were less likely to be smokers, were more exposed to passive smoking/biomass, and were more depressed compared to males. The rates of bronchiectasis, previous childhood respiratory infection, and asthma were higher in females. Female patients also had more symptoms and a poorer exercise capacity than males, but no significant differences were observed in terms of exacerbations. Radiologic findings revealed that male patients had worse emphysema, and female patients had worse bronchiectasis, as determined based on chest X-ray and computed tomography findings. On pulmonary function tests, female patients had less obstruction and less annual FEV1 loss over 5 years. CONCLUSION This study revealed differences in the clinical parameters between male and female patients with COPD, including general characteristics, disease characteristics, and clinical outcomes.
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shin Young Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul134-701, Republic of Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Soo-Jung Um
- Division of Respiratory Medicine, Department of Internal Medicine, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, Republic of Korea
| | - Ki Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seoung Ju Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Hyoung Kyu Yoon Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, #62 Youido-Dong Yeongdeungpo-Gu, Seoul, Republic of KoreaTel +82 2 3779 2213Fax +82 2 780 3132 Email
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Breyer-Kohansal R, Hartl S, Burghuber OC, Urban M, Schrott A, Agusti A, Sigsgaard T, Vogelmeier C, Wouters E, Studnicka M, Breyer MK. The LEAD (Lung, Heart, Social, Body) Study: Objectives, Methodology, and External Validity of the Population-Based Cohort Study. J Epidemiol 2019; 29:315-324. [PMID: 30344197 PMCID: PMC6614076 DOI: 10.2188/jea.je20180039] [Citation(s) in RCA: 15] [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] [Received: 04/12/2018] [Accepted: 07/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Lung, hEart, sociAl, boDy (LEAD) Study (ClinicalTrials.gov; NCT01727518; http://clinicaltrials.gov) is a longitudinal, observational, population-based Austrian cohort that aims to investigate the relationship between genetic, environmental, social, developmental and ageing factors influencing respiratory health and comorbidities through life. The general working hypothesis of LEAD is the interaction of these genetic, environmental and socioeconomic factors influences lung development and ageing, the risk of occurrence of several non-communicable diseases (respiratory, cardiovascular, metabolic and neurologic), as well as their phenotypic (ie, clinical) presentation. METHODS LEAD invited from 2011-2016 a random sample (stratified by age, gender, residential area) of Vienna inhabitants (urban cohort) and all the inhabitants of six villages from Lower Austria (rural cohort). Participants will be followed-up every four years. A number of investigations and measurements were obtained in each of the four domains of the study (Lung, hEart, sociAl, boDy) including data to screen for lung, cardiovascular and metabolic diseases, osteoporosis, and cognitive function. Blood and urine samples are stored in a biobank for future investigations. RESULTS A total of 11.423 males (47.6%) and females (52.4%), aged 6-80 years have been included in the cohort. Compared to governmental statistics, the external validity of LEAD with respect to age, gender, citizenship, and smoking status was high. CONCLUSIONS In conclusion, the LEAD cohort has been established following high quality standards; it is representative of the Austrian population and offers a platform to understand lung development and ageing as a key mechanism of human health both in early and late adulthood.
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Affiliation(s)
- Robab Breyer-Kohansal
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Sylvia Hartl
- Second Department of Respiratory Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Otto Chris Burghuber
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, and Sigmund Freud University, Medical School, Vienna, Austria
| | - Matthias Urban
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Andrea Schrott
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and National Spanish Network for Respiratory Research (CIBERES), Barcelona, Spain
| | - Torben Sigsgaard
- Institute of Public Health, Environmental and Occupational Medicine, Aarhus University, Aarhus, Denmark
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Emiel Wouters
- Department of Respiratory Medicine+, MUMC+, Maastricht University, Maastricht, the Netherlands
| | - Michael Studnicka
- Department of Respiratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Marie-Kathrin Breyer
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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Sator L, Horner A, Studnicka M, Lamprecht B, Kaiser B, McBurnie MA, Buist AS, Gnatiuc L, Mannino DM, Janson C, Bateman ED, Burney P. Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis. Chest 2019; 156:277-288. [PMID: 30711480 DOI: 10.1016/j.chest.2019.01.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. METHODS A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). RESULTS Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. CONCLUSIONS False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.
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Affiliation(s)
- Lea Sator
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Horner
- Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria; Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Bernhard Kaiser
- Department of Pulmonology, Kepler University Hospital, Linz, Austria
| | - Mary Ann McBurnie
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Luisa Gnatiuc
- Respiratory Epidemiology and Public Health Group, Imperial College, London, London, United Kingdom
| | - David M Mannino
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY
| | - Christer Janson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eric D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Burney
- Respiratory Epidemiology and Public Health Group, Imperial College, London, London, United Kingdom
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Walsh A, Perrem L, Khashan AS, Henry MT, Ni Chroinin M. Statins versus placebo for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; 7:CD011959. [PMID: 31425628 PMCID: PMC6699658 DOI: 10.1002/14651858.cd011959.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable respiratory disease. COPD exacerbations are associated with worse quality of life, increased hospitalisations, and increased mortality. Currently available pharmacological interventions have variable impact on exacerbation frequency. The anti-inflammatory effects of statins may lead to decreased pulmonary and systemic inflammation, resulting in fewer exacerbations of COPD. Several observational studies have shown potential benefits of statins for patients with COPD. OBJECTIVES This review aims to evaluate available evidence on benefits and harms associated with statin therapy compared with placebo as adjunct therapy for patients with COPD. Primary objectives include the following.• To determine whether statins reduce mortality rates in COPD.• To determine whether statins reduce exacerbation frequency, improve quality of life, or improve lung function in COPD.• To determine whether statins are associated with adverse effects. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent search on 20 May 2019. SELECTION CRITERIA Parallel, randomised controlled trials recruiting adults with COPD. DATA COLLECTION AND ANALYSIS We used standard methods as expected by Cochrane. Prespecified primary outcomes were number of exacerbations, all-cause mortality, and COPD-specific mortality. MAIN RESULTS Eight studies including 1323 participants with COPD were included in the review. Participants had a mean age of 61.4 to 72 years, and most were male (median 73.4%). Mean baseline forced expiratory volume in one second (FEV₁) ranged from 41% to 90% predicted. All studies compared moderate- or high-intensity statin therapy versus placebo. The duration of treatment ranged from 12 weeks to 36 months.We found no statistically significant difference between statins and placebo in our primary outcome of number of exacerbations per person-year (mean difference (MD) -0.03, 95% confidence interval (CI) -0.25 to 0.19, 1 trial, 877 participants), including number of exacerbations requiring hospitalisation per person-year (MD 0.00, 95% CI -0.10 to 0.10, 1 trial, 877 exacerbations). This evidence was of moderate quality after downgrading for unclear risk of bias. Our primary outcomes of all-cause mortality (odds ratio (OR) 1.03, 95% CI 0.61 to 1.74, 2 trials, 952 participants) and COPD-specific mortality (OR 1.25, 95% CI 0.38 to 4.13, 1 trial, 877 participants) showed no significant difference between statins and placebo, with wide confidence intervals suggesting uncertainty about the precision of the results. This evidence was of low quality after downgrading for unclear risk of bias and imprecision.Results of the secondary outcomes analysis showed no clear differences between statins and placebo for FEV₁ (% predicted) (MD 1.18, 95% CI -2.6 to 4.97, 6 trials, 325 participants) but did show a statistically significant improvement in FEV₁/forced vital capacity (FVC) (MD 2.66, 95% CI 0.12 to 5.2; P = 0.04; 6 trials, 325 participants). A sensitivity analysis excluding two trials at high risk of bias showed no statistically significant difference in FEV₁/FVC (MD 2.05, 95% CI -0.87 to -4.97; P = 0.17; 4 trials, 255 participants). We also found no significant differences between the two groups in functional capacity measured by six-minute walk distance in metres (MD 1.79, 95% CI -52.51 to 56.09, 3 trials, 71 participants), with wide confidence intervals suggesting uncertainty about the precision of the results. Results show no clear difference in quality of life, which was reported in three trials, and a slight reduction in C-reactive protein (CRP) in the intervention group, which was statistically significant (MD -1.03, 95% CI -1.95 to -0.11; I² = 0%, P = 0.03; 3 trials, 142 participants). We noted a significant reduction in interleukin (IL)-6 in the intervention group (MD -2.11, 95% CI -2.65 to -1.56; I² = 0%, P ≤ 0.00001; 2 trials, 125 participants). All trials mentioned adverse events and indicated that statins were generally well tolerated. One study reported adverse events in detail and indicated that rates of all non-fatal adverse events (the number of serious adverse events per person-year) were similar in both groups (0.63 ± 1.56 events (intervention group) and 0.62 ± 1.48 events (control group); P > 0.20) for all comparisons, except for non-fatal serious adverse events involving the gastrointestinal tract, which were more frequent in the intervention group (in 30 patients (0.05 events per person-year) vs 17 patients (0.02 events per person-year); P = 0.02). Another trial lists the total numbers and percentages of adverse events in the intervention group (12 (26%)) and in the control group (21 (43%)) and of serious adverse events in the intervention group (4 (9%)) and in the control group (3 (6%)).The other trials stated that researchers found no significant adverse effects of statins but did not report adverse events in detail. AUTHORS' CONCLUSIONS A small number of trials providing low- or moderate-quality evidence were suitable for inclusion in this review. They showed that use of statins resulted in a reduction in CRP and IL-6, but that this did not translate into clear clinical benefit for people with COPD. Further randomised controlled trials are needed to explore this topic.
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Affiliation(s)
- Aisling Walsh
- Cork University HospitalDepartment of PaediatricsCorkIreland
| | - Lucy Perrem
- The Hospital for Sick Children (SickKids)TorontoCanada
| | - Ali S Khashan
- University College CorkSchool of Public HealthCorkIreland
- University College CorkIrish Centre for Fetal and Neonatal Translational Research (INFANT)CorkIreland
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Ho T, Cusack RP, Chaudhary N, Satia I, Kurmi OP. Under- and over-diagnosis of COPD: a global perspective. Breathe (Sheff) 2019; 15:24-35. [PMID: 30838057 PMCID: PMC6395975 DOI: 10.1183/20734735.0346-2018] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Globally, chronic obstructive pulmonary disease (COPD) is the fourth major cause of mortality and morbidity and projected to rise to third within a decade as our efforts to prevent, identify, diagnose and treat patients at a global population level have been insufficient. The European Respiratory Society and American Thoracic Society, along with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document, have highlighted key pathological risk factors and suggested clinical treatment strategies in order to reduce the mortality and morbidity associated with COPD. This review focuses solely on issues related to the under- and over-diagnosis of COPD across the main geographical regions of the world and highlights some of the associated risk factors. Prevalence of COPD obtained mainly from epidemiological studies varies greatly depending on the clinical and spirometric criteria used to diagnose COPD, i.e. forced expiratory volume in 1 s to forced vital capacity ratio <0.7 or 5% below the lower limit of normal, and this subsequently affects the rates of under- and over-diagnosis. Although under-utilisation of spirometry is the major reason, additional factors such as exposure to airborne pollutants, educational level, age of patients and language barriers have been widely identified as other potential risk factors. Co-existent diseases, such as asthma, bronchiectasis, heart failure and previously treated tuberculosis, are reported to be the other determinants of under- and over-diagnosis of COPD. COPD is a major cause of morbidity and mortality, but misdiagnosis of COPD is a huge problem worldwide. Its main causes are under-utilisation of spirometry and lack of uniformity in diagnosis criteria, particularly in resource poor settings.http://ow.ly/KfP330nonkh
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Affiliation(s)
- Terence Ho
- Firestone Institute of Respiratory Health, Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Ruth P Cusack
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Nagendra Chaudhary
- Dept of Paediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.,All authors contributed equally
| | - Imran Satia
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Om P Kurmi
- Population Health Research Institute, Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
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18
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Carratalá-Munuera C, Arriero-Marin JM, Orozco-Beltrán D, Cuneo Amat B, Lopez-Pineda A, Soler-Cataluña JJ, Gil-Guillén VF, Quesada Rico JA. Percepción de calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica en España. OPEN RESPIRATORY ARCHIVES 2019. [DOI: 10.1016/j.opresp.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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19
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Broström E, Jõgi R, Gislason T, Benediktsdottir B, Burney PGJ, Janson C. The prevalence of chronic airflow obstruction in three cities in the Nordic-Baltic region. Respir Med 2018; 143:8-13. [PMID: 30261997 DOI: 10.1016/j.rmed.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/23/2018] [Accepted: 08/12/2018] [Indexed: 12/21/2022]
Abstract
BACK GROUND Chronic airflow obstruction (CAO) is the primary characteristic of Chronic obstructive pulmonary disease (COPD) but is also seen in chronic asthma. OBJECTIVE To compare the prevalence of CAO and possible risk factors between Tartu in Estonia, Reykjavik in Iceland and Uppsala in Sweden. METHODS All participants underwent spirometry testing of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) before and after bronchodilation. CAO was defined as post-bronchodilator FEV1/FVC below lower limit of normal. Information on respiratory diseases and smoking status, was obtained through questionnaires administered by trained interviewers. RESULTS 1037 men and 956 women participated in the study. The prevalence of CAO was lower in women in Tartu compared to the other centres (4.9% vs. 13.4 and 8.7% in Reykjavik and Uppsala, respectively, p = 0.002) while no difference was found for men. A similar picture was seen for the proportion of participants that had smoked 10 pack years or more which was much lower in Tartu for women than in Reykjavik and Uppsala, respectively (13.2% vs. 33.7 and 29.2%, p < 0.001). (Fig. 1). Of the participants with CAO the majority (57-67%) did not have a previous diagnosis of asthma or COPD. CONCLUSION The prevalence of CAO was lower in Estonian women than in women from Iceland and Sweden. The reason for this was probably that the Estonian women had smoked less than the female participants from Iceland and Sweden. The majority of those with CAO do not have a diagnosed lung disease.
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Affiliation(s)
- Erika Broström
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Sweden
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Iceland
| | | | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Sweden; National Heart and Lung Institute, Imperial College, London, UK.
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Sari Kundt F, Enthaler N, Dieplinger AM, Studnicka M, Knoll A, Osterbrink J, Johansson T, Flamm M. Multiprofessional COPD care in Austria-challenges and approaches : Results of a qualitative study. Wien Klin Wochenschr 2018; 130:371-381. [PMID: 29808349 PMCID: PMC6008351 DOI: 10.1007/s00508-018-1346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/05/2018] [Indexed: 12/03/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a frequent disease of the lungs. Its prevalence was estimated to be 26% in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I and 11% for GOLD II–IV in Austria. Globally, it ranks third in mortality rate. The particular challenge is that care for these patients falls short due to the lack of structured integrated care. The aim was to assess the current status of multiprofessional COPD care in Austria and identify gaps and potentials. Methods We conducted guided focus group interviews between March and July 2016 addressing current COPD care and treatment gaps with the following professional and interest groups: general practitioners, nurses, patients, pharmacists, physiotherapists and pulmonologists. We interviewed 23 patients and 27 healthcare professionals. The interviews were transcribed verbatim and coded into 12 relevant categories. Results There needs to be a shift in thinking from treatment-based care to prevention. Patients, just like healthcare professionals, need periodic updates and comprehensive information on this disease. Creating internet platforms with useful information for COPD patients and solving the data privacy issues of the Austrian electronic medical record (ELGA) are also perceived as viable steps. There is a need and request for healthcare professionals to work as a team with clear COPD management guidelines in the outpatient sector, the establishment of outpatient rehabilitation centers as well as creating a new professional profile, the COPD nurse. Conclusion Current COPD care needs to be reorganized, particularly in the outpatient sector, to address the needs of patients and healthcare professionals.
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Affiliation(s)
- Firuzan Sari Kundt
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Nina Enthaler
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Anna Maria Dieplinger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Michael Studnicka
- Department of Pneumology, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
| | - Anna Knoll
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Tim Johansson
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Maria Flamm
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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Blanco I, Diego I, Bueno P, Fernández E, Casas-Maldonado F, Esquinas C, Soriano JB, Miravitlles M. Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique. Int J Chron Obstruct Pulmon Dis 2017; 13:57-67. [PMID: 29317811 PMCID: PMC5743112 DOI: 10.2147/copd.s150853] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Existing data on COPD prevalence are limited or totally lacking in many regions of Europe. The geographic information system inverse distance weighted (IDW) interpolation technique has proved to be an effective tool in spatial distribution estimation of epidemiological variables, when real data are few and widely separated. Therefore, in order to represent cartographically the prevalence of COPD in Europe, an IDW interpolation mapping was performed. The point prevalence data provided by 62 studies from 19 countries (21 from 5 Northern European countries, 11 from 3 Western European countries, 14 from 5 Central European countries, and 16 from 6 Southern European countries) were identified using validated spirometric criteria. Despite the lack of data in many areas (including all regions of the eastern part of the continent), the IDW mapping predicted the COPD prevalence in the whole territory, even in extensive areas lacking real data. Although the quality of the data obtained from some studies may have some limitations related to different confounding factors, this methodology may be a suitable tool for obtaining epidemiological estimates that can enable us to better address this major public health problem.
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Affiliation(s)
- Ignacio Blanco
- Alpha1-Antitrypsin Deficiency Spanish Registry, Lung Foundation Breathe, Spanish Society of Pneumology, Barcelona
| | - Isidro Diego
- Materials and Energy Department, School of Mining Engineering, Oviedo University
| | | | - Eloy Fernández
- Clinical Analysis Laboratory, University Hospital of Cabueñes, Principality of Asturias
| | | | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona
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Weiss G, Steinacher I, Lamprecht B, Kaiser B, Mikes R, Sator L, Hartl S, Wagner H, Studnicka M. Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study. NPJ Prim Care Respir Med 2017; 27:4. [PMID: 28127061 PMCID: PMC5434771 DOI: 10.1038/s41533-016-0005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/30/2016] [Accepted: 10/25/2016] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to "breathing problems", "wheeze", "cough", "limitation of physical activity", and "smoking". At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding. CHRONIC OBSTRUCTIVE PULMONARY DISEASE QUESTIONNAIRE FOR PRE-SCREENING POTENTIAL SUFFERERS: Scientists in Austria have developed a brief, simple questionnaire to identify patients likely to have early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) is notoriously difficult to diagnose, and the condition often causes irreversible lung damage before it is identified. Finding a simple, cost-effective method of pre-screening patients with suspected early-stage COPD could potentially improve treatment responses and limit the burden of extensive lung function ('spirometry') tests on health services. Gertraud Weiss at Paracelsus Medical University, Austria, and co-workers have developed and validated an easy-to-use, self-administered questionnaire that could prove effective for pre-screening patients. The team trialed the five-point Salzburg COPD-screening questionnaire on 1258 patients. Patients scoring 2 points or above on the questionnaire underwent spirometry tests. The questionnaire seems to provide a sensitive and cost-effective way of pre-selecting patients for spirometry referral.
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Affiliation(s)
- Gertraud Weiss
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria.
| | - Ina Steinacher
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler-University-Hospital, Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Bernhard Kaiser
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Romana Mikes
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Lea Sator
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Helga Wagner
- Department for Statistics, University of Linz, Linz, Austria
| | - M Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
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Ferguson GT, Karpel JP, Clerisme-Beaty E, Grönke L, Voß F, Buhl R. Efficacy and safety of tiotropium + olodaterol maintenance treatment in patients with COPD in the TONADO ® and OTEMTO ® studies: a subgroup analysis by age. Int J Chron Obstruct Pulmon Dis 2016; 11:2701-2710. [PMID: 27843306 PMCID: PMC5098524 DOI: 10.2147/copd.s108758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Increasing age is associated with poor prognosis in patients with COPD. Objective This analysis from the replicate Phase III OTEMTO® and TONADO® studies examined the efficacy and safety of tiotropium, a long-acting anticholinergic, combined with olodaterol, a long-acting β2-agonist, compared to monotherapies and placebo in patients with COPD aged 40 years to <65 years, 65 years to <75 years, 75 years to <85 years, and ≥85 years. Methods In these double-blind, parallel-group, active-controlled, multicenter, randomized studies, patients received tiotropium + olodaterol 2.5/5 μg or 5/5 μg, tiotropium 5 μg or 2.5 μg (TONADO only), olodaterol 5 μg (TONADO only), or placebo (OTEMTO only). This analysis used the approved doses of tiotropium + olodaterol 5/5 μg, tiotropium 5 μg, and olodaterol 5 μg. Primary end points at 12 weeks (OTEMTO) or 24 weeks (TONADO) included St George’s Respiratory Questionnaire (SGRQ) total score, forced expiratory volume in 1 second (FEV1) area under the curve from 0 hour to 3 hours (AUC0–3) response, and trough FEV1 response. Results A total of 1,621 patients were randomized (40 years to <65 years, n=749; 65 years to <75 years, n=674; 75 years to <85 years, n=186; ≥85 years, n=12) in OTEMTO and 5,162 patients (40 years to <65 years, n=2,654; 65 years to <75 years, n=1,967; 75 to <85 years, n=528; ≥85 years, n=13) in TONADO. FEV1 AUC0–3 and trough FEV1 responses improved with tiotropium + olodaterol 5/5 μg at 12 weeks and 24 weeks compared to monotherapies or placebo for all age groups. SGRQ scores generally improved with tiotropium + olodaterol 5/5 μg after 12 weeks in OTEMTO and improved after 24 weeks in all age groups in TONADO. In all age groups receiving tiotropium + olodaterol 5/5 μg compared to monotherapies or placebo, transition dyspnea index scores generally improved, while rescue medication usage improved. Conclusion No differences were noted in relative responses to treatment or safety when using tiotropium + olodaterol 5/5 μg compared to monotherapies or placebo across all age groups.
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Affiliation(s)
- Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI
| | | | | | - Lars Grönke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - Florian Voß
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
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Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, Nair H, Gasevic D, Sridhar D, Campbell H, Chan KY, Sheikh A, Rudan I. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health 2016. [PMID: 26755942 PMCID: PMC4693508 DOI: 10.7189/jogh.05-020415] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases. Methods We conducted a systematic search of Medline, EMBASE and Global Health for original, population–based studies providing spirometry–based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta–analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta–estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta–regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more. Findings Our search returned 37 472 publications. A total of 123 studies based on a spirometry–defined prevalence were retained for the review. From the meta–regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%–14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–8.2%) in women. Conclusions Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Stephen Chua
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Chinwei Lee
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Catriona Basquill
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Angeliki Papana
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harish Nair
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Danijela Gasevic
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Devi Sridhar
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harry Campbell
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Aziz Sheikh
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Ding Y, Yang D, He P, Yao J, Sun P, Li Q, Xie P, Lin D, Sun D, Niu H, Tian Z. Prevalence and risk factors of chronic obstructive pulmonary diseases in a Hlai community in Hainan Island of China. CLINICAL RESPIRATORY JOURNAL 2016; 12:126-133. [PMID: 27216214 DOI: 10.1111/crj.12497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/30/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Yipeng Ding
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Danlei Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital; Tongji Medical College, Huazhong University of Science and Technology; Wuhan Hubei People's Republic of China
| | - Ping He
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Jinjian Yao
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Pei Sun
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Quanni Li
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Pingdong Xie
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Daobo Lin
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Dingwei Sun
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Huan Niu
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Zhongjie Tian
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
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Sharifi H, Masjedi MR, Emami H, Ghanei M, Eslaminejad A, Radmand G, Buist S. Burden of obstructive lung disease study in Tehran: Prevalence and risk factors of chronic obstructive pulmonary disease. Lung India 2015; 32:572-7. [PMID: 26664162 PMCID: PMC4663859 DOI: 10.4103/0970-2113.168129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) was ranked the sixth-most common cause of death worldwide in 1990, but now it is the third-most common cause. The goal of the present study was to assess the prevalence and determine the causes and risk factors of COPD in Tehran. Materials and Methods: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The target population was all non-institutionalized inhabitants, aged 18 to 40 in one group and over 40 in another who resided in Tehran in 2013. The core questionnaire was developed from pre-existing validated questionnaires that had already been used in multi-national studies. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (two puffs) of salbutamol. Results: The most commonly reported respiratory symptoms were: sputum production in 291 patients (16.2%) [95% confidence interval (CI): 14.5-17.9%], chronic cough in 171 (9.5%) (95% CI: 8.2-10.9%), wheezing in 377 (21.0%) (95%CI: 19.1-22.9%) and dyspnea in 388 patients (21.6%) (95% CI: 19.7-23.5%). The overall COPD prevalence defined by the post-bronchodilator spirometric functional criteria was 9.2%. This value in men (10.1%) was higher than in women (8.5%); the prevalence was significantly higher in subjects aged over 55 years (P ≤ 0.002). The prevalence of COPD was strongly dependent on smoking status, especially in ex-smokers, and increased considerably with age. 69% of patients with COPD were non-smoker. Conclusion: The high prevalence of verified COPD, a great deal of which was undiagnosed before by a physician, highlights the necessity of raising awareness of this disease among health professionals, and use of spirometry in the primary care setting. A future cross-sectional and prospective cohort study should be performed to explore all risk factors and their impact on decline in lung function and worsening of respiratory symptoms especially in non-smokers.
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Affiliation(s)
- Hooman Sharifi
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Masjedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Baqiyatallah Research Center of Gastroentrology and Liver diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Eslaminejad
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnar Radmand
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sonia Buist
- Oregon Health and Science University, Portland, Oregon, USA
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27
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Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, Nair H, Gasevic D, Sridhar D, Campbell H, Chan KY, Sheikh A, Rudan I. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health 2015; 5:020415. [PMID: 26755942 PMCID: PMC4693508 DOI: 10.7189/jogh.05.020415] [Citation(s) in RCA: 550] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases. METHODS We conducted a systematic search of Medline, EMBASE and Global Health for original, population-based studies providing spirometry-based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta-analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta-estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta-regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more. FINDINGS Our search returned 37 472 publications. A total of 123 studies based on a spirometry-defined prevalence were retained for the review. From the meta-regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%-14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%-15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%-15.3%) compared to 7.6% (95% CI 7.0%-8.2%) in women. CONCLUSIONS Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Stephen Chua
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Chinwei Lee
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Catriona Basquill
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Angeliki Papana
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harish Nair
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Danijela Gasevic
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Devi Sridhar
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harry Campbell
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Aziz Sheikh
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Kamenski G, Bendova J, Fink W, Sönnichsen A, Spiegel W, Zehetmayer S. Does COPD have a clinically relevant impact on hearing loss? A retrospective matched cohort study with selection of patients diagnosed with COPD. BMJ Open 2015; 5:e008247. [PMID: 26586319 PMCID: PMC4654383 DOI: 10.1136/bmjopen-2015-008247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) as a multisystemic disease has a measurable and biologically explainable impact on the auditory function detectable in the laboratory. This study tries to clarify if COPD is also a significant and clinically relevant risk factor for hearing impairment detectable in the general practice setting. DESIGN Retrospective matched cohort study with selection of patients diagnosed with COPD. SETTING 12 general practices in Lower Austria. PARTICIPANTS Consecutive patients >35 years with a diagnosis of COPD who consulted 1 of 12 single-handed GPs in 2009 and 2010 were asked to participate. Those who agreed were individually 1:1 matched with controls according to age, sex, hypertension, diabetes, coronary heart disease and chronic heart failure. MAIN OUTCOME MEASURES Sensorineural hearing impairment as assessed by pure tone audiometry, answers of three questions concerning a self-perceived hearing problem, application of the whispered voice test and the score of the Hearing Inventory for the Elderly, Screening Version (HHIE-S). RESULTS 194 patients (97 pairs of 194 cases and controls) with a mean age of 65.5 (SD 10.2) were tested. Univariate conditional logistic regression resulted in significant differences in the mean bone conduction hearing loss and in the total score of HHIE-S, in the multiple conditional regression model, only smoking (p<0.0001) remained significant. CONCLUSIONS The results of this study do not support the hypothesis that there is an association between COPD and hearing impairment which, if found, would have allowed better management of patients with COPD.
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Affiliation(s)
- Gustav Kamenski
- Department of General Practice, Centre for Public Health, Medical University Vienna, Vienna, Austria
| | - Jana Bendova
- Department of General Medicine, Surgery for adults Velky Biel, Velky Biel, Slovakia
| | - Waltraud Fink
- Karl Landsteiner Institute for Systematics in General Medicine, Angern, Austria
| | - Andreas Sönnichsen
- General Practice and Family Medicine, Institute of General Practice and Family Medicine, Witten/Herdecke University, Witten, Germany
| | - Wolfgang Spiegel
- Centre for Public Health, Medical University Vienna, Vienna, Austria
| | - Sonja Zehetmayer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
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Walsh A, Perrem LM, Elshafi M, Khashan AS, Henry M, Ni Chroinin M. Statins versus placebo for people with chronic obstructive pulmonary disease (COPD). Hippokratia 2015. [DOI: 10.1002/14651858.cd011959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Aisling Walsh
- Cork University Hospital; Department of Paediatrics; Cork Ireland
| | - Lucy M Perrem
- Tallaght Hospital (AMNCH); Respiratory; Dublin Ireland
| | - Mohamed Elshafi
- Cork University Hospital; Respiratory Medicine; Cork Ireland
| | - Ali S Khashan
- University College Cork; Irish Centre for Fetal and Neonatal Translational Research (INFANT); 5th Floor, Cork University Maternity Hospital Wilton Cork Munster Ireland
- University College Cork; Department of Epidemiology and Public Health; Cork Ireland
| | - Michael Henry
- Cork University Hospital; Respiratory Medicine; Cork Ireland
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Obaseki DO, Erhabor GE, Gnatiuc L, Adewole OO, Buist SA, Burney PG. Chronic Airflow Obstruction in a Black African Population: Results of BOLD Study, Ile-Ife, Nigeria. COPD 2015; 13:42-9. [PMID: 26451840 DOI: 10.3109/15412555.2015.1041102] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Global estimates suggest that Chronic Obstructive Pulmonary Disease (COPD) is emerging as a leading cause of death in developing countries but there are few spirometry-based general population data on its prevalence and risk factors in sub-Saharan Africa. We used the Burden of Obstructive Lung Disease (BOLD) protocol to select a representative sample of adults aged 40 years and above in Ile-Ife, Nigeria. All the participants underwent spirometry and provided information on smoking history, biomass and occupational exposures as well as diagnosed respiratory diseases and symptoms. Chronic Airflow Obstruction (CAO) was defined as the ratio of post-bronchodilator (BD) one second Forced Expiratory Volume (FEV1) to Forced Vital Capacity (FVC) below the lower limit of normal (LLN) of the population distribution for FEV1/FVC. The overall prevalence of obstruction (post-BD FEV1/FVC < LLN) was 7.7% (2.7% above LLN) using Global Lung Function Initiative (GLI) equations. It was associated with few respiratory symptoms; 0.3% reported a previous doctor-diagnosed chronic bronchitis, emphysema or COPD. Independent predictors included a lack of education (OR 2.5, 95% CI: 1.0, 6.4) and a diagnosis of either TB (OR 23.4, 95% CI: 2.0, 278.6) or asthma (OR 35.4, 95%CI: 4.9, 255.8). There was no association with the use of firewood or coal for cooking or heating. The vast majority of this population (89%) are never smokers. We conclude that the prevalence of CAO is low in Ile-Ife, Nigeria and unrelated to biomass exposure. The key independent predictors are poor education, and previous diagnosis of tuberculosis or asthma.
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Affiliation(s)
- Daniel O Obaseki
- a 1 Department of Medicine , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Gregory E Erhabor
- a 1 Department of Medicine , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Louisa Gnatiuc
- b 2 National Heart and Lung Institute, Imperial College , London , United Kingdom
| | - Olufemi O Adewole
- a 1 Department of Medicine , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Sonia A Buist
- c 3 Division of Pulmonary and Critical Care, Oregon Health and Sciences University , Portland , Oregon , USA
| | - Peter G Burney
- b 2 National Heart and Lung Institute, Imperial College , London , United Kingdom
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Liu S, Ren Y, Wen D, Chen Y, Chen D, Li L, Zhang X, Zhang Y, Fu S, Li Z, Xia S, Wang D, Chen H, Zhao J, Wang X. Prevalence and risk factors for COPD in greenhouse farmers: a large, cross-sectional survey of 5,880 farmers from northeast China. Int J Chron Obstruct Pulmon Dis 2015; 10:2097-108. [PMID: 26491280 PMCID: PMC4599073 DOI: 10.2147/copd.s79264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background COPD is one of the most common chronic diseases, and more and more farmers who were frequently exposed to greenhouse environments were diagnosed with COPD. However, little information is available on the prevalence of COPD among the greenhouse farmers. This study was conducted to assess the prevalence of COPD and investigate the potential risk factors for COPD among the Chinese greenhouse farmers. Methods Cross-sectional studies involving a sample of greenhouse farmers living in northeast China were performed via stratified-cluster-random sampling. All subjects were interviewed using a uniform questionnaire and underwent pulmonary function tests between 2006 and 2009, based on the diagnostic criteria of the Global Initiative for Chronic Obstructive Lung Disease. Multiple logistic regression analysis was conducted to examine the risk factors for COPD. Results Of the 5,880 greenhouse farmers from northeast China who were originally selected for this study, 5,420 questionnaires were completed. The overall prevalence of COPD in greenhouse farmers was 17.5%. The COPD prevalence was significantly higher in elderly subjects (≥50 years), current smokers, in those with lower body mass index (≤18.5 kg/m2) and less education, in those who were exposed to mushroom, flowers and poultry, and in those living in mountain and coastal region. Multiple logistic regression analysis revealed that age over 50 years old (odds ratio [OR]=298.69, 95% confidence interval [CI]=121.57–733.84), smoking (OR=2.18, 95% CI=1.84–2.59), planting mushroom and flowers (OR=1.46 and 1.53, 95% CI=1.13–1.87 and 1.24–1.95), and living in mountain and coastal region (OR=1.68 and 1.35, 95% CI=1.37–2.06 and 1.10–1.65) were associated with the development of COPD among greenhouse farmers. Conclusion In northeast China, COPD is highly prevalent among greenhouse farmers, and advanced age, smoking, planting mushroom, and flowers, as well as living in mountain and coastal regions, are potential risk factors for this disease.
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Affiliation(s)
- Shuo Liu
- The Fourth Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Yangang Ren
- The Fourth Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Deliang Wen
- The Fourth Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Yu Chen
- The Second Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Donghong Chen
- The Fourth Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Liyun Li
- The First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Xuhua Zhang
- The Fourth Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Yibing Zhang
- The Shenyang Military General Hospital, Shenyang, Liaoning, People's Republic of China
| | - Shuang Fu
- The General Hospital of Fushun Mining Bureau, Fushun, Liaoning, People's Republic of China
| | - Zhenhua Li
- The First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Shuyue Xia
- Fengtian Hospital, Shenyang Medical College, Liaoning, People's Republic of China
| | - Dongliang Wang
- 202nd Hospital of People's Liberation Army, Shenyang, Liaoning, People's Republic of China
| | - Hong Chen
- The First People's Hospital of Kazuo, Chaoyang, Liaoning, People's Republic of China
| | - Jian Zhao
- 205th Hospital of People's Liberation Army, Jinzhou, Liaoning, People's Republic of China
| | - Xiaoge Wang
- The Fourth Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
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Robitaille C, Dajczman E, Hirsch AM, Small D, Ernst P, Porubska D, Palayew M. Implementation of a targeted screening program to detect airflow obstruction suggestive of chronic obstructive pulmonary disease within a presurgical screening clinic. Can Respir J 2015; 22:209-14. [PMID: 25961279 PMCID: PMC4530853 DOI: 10.1155/2015/306720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization. OBJECTIVE The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program. METHODS The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews. RESULTS After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers. CONCLUSIONS Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.
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Affiliation(s)
| | - Esther Dajczman
- Airways Centre, Division of Pulmonary Diseases, McGill University
- Department of Nursing, Jewish General Hospital, McGill University
- Mount Sinai Hospital, Montreal, Quebec
| | - Andrew M Hirsch
- Airways Centre, Division of Pulmonary Diseases, McGill University
| | - David Small
- Airways Centre, Division of Pulmonary Diseases, McGill University
| | - Pierre Ernst
- Airways Centre, Division of Pulmonary Diseases, McGill University
| | - Dana Porubska
- Department of Nursing, Jewish General Hospital, McGill University
| | - Mark Palayew
- Airways Centre, Division of Pulmonary Diseases, McGill University
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Grabcanovic-Musija F, Obermayer A, Stoiber W, Krautgartner WD, Steinbacher P, Winterberg N, Bathke AC, Klappacher M, Studnicka M. Neutrophil extracellular trap (NET) formation characterises stable and exacerbated COPD and correlates with airflow limitation. Respir Res 2015; 16:59. [PMID: 25994149 PMCID: PMC4455316 DOI: 10.1186/s12931-015-0221-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/13/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND COPD is a progressive disease of the airways that is characterized by neutrophilic inflammation, a condition known to promote the excessive formation of neutrophil extracellular traps (NETs). The presence of large amounts of NETs has recently been demonstrated for a variety of inflammatory lung diseases including cystic fibrosis, asthma and exacerbated COPD. OBJECTIVE We test whether excessive NET generation is restricted to exacerbation of COPD or whether it also occurs during stable periods of the disease, and whether NET presence and amount correlates with the severity of airflow limitation. PATIENTS, MATERIALS AND METHODS Sputum samples from four study groups were examined: COPD patients during acute exacerbation, patients with stable disease, and smoking and non-smoking controls without airflow limitation. Sputum induction followed the ECLIPSE protocol. Confocal laser microscopy (CLSM) and electron microscopy were used to analyse samples. Immunolabelling and fluorescent DNA staining were applied to trace NETs and related marker proteins. CLSM specimens served for quantitative evaluation. RESULTS Sputum of COPD patients is clearly characterised by NETs and NET-forming neutrophils. The presence of large amounts of NET is associated with disease severity (p < 0.001): over 90 % in exacerbated COPD, 45 % in stable COPD, and 25 % in smoking controls, but less than 5% in non-smokers. Quantification of NET-covered areas in sputum preparations confirms these results. CONCLUSIONS NET formation is not confined to exacerbation but also present in stable COPD and correlates with the severity of airflow limitation. We infer that NETs are a major contributor to chronic inflammatory and lung tissue damage in COPD.
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Affiliation(s)
- Fikreta Grabcanovic-Musija
- University Clinic of Pneumology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
| | - Astrid Obermayer
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Walter Stoiber
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Wolf-Dietrich Krautgartner
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Peter Steinbacher
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Nicole Winterberg
- Department of Mathematics, University of Salzburg, Salzburg, Austria.
| | | | - Michaela Klappacher
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Michael Studnicka
- University Clinic of Pneumology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
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Mehari A, Gillum RF. Chronic obstructive pulmonary disease in African- and European-American women: morbidity, mortality and healthcare utilization in the USA. Expert Rev Respir Med 2015; 9:161-70. [DOI: 10.1586/17476348.2015.1016502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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35
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van Dijk W, Tan W, Li P, Guo B, Li S, Benedetti A, Bourbeau J. Clinical relevance of fixed ratio vs lower limit of normal of FEV1/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med 2015; 13:41-8. [PMID: 25583891 PMCID: PMC4291264 DOI: 10.1370/afm.1714] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The way in which spirometry is interpreted can lead to misdiagnosis of chronic obstructive pulmonary disease (COPD) resulting in inappropriate treatment. We compared the clinical relevance of 2 criteria for defining a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC): the fixed ratio and the lower limit of normal. METHODS We analyzed data from the cross-sectional phase of the population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. We determined associations of the spirometric criteria for airflow limitation with patient-reported adverse outcomes, including respiratory symptoms, disability, health status, exacerbations, and cardiovascular disease. Sensitivity analyses were used to explore the impact of age and severity of airflow limitation on these associations. RESULTS We analyzed data from 4,882 patients aged 40 years and older. The prevalence of airflow limitation was 17% by fixed ratio and 11% by lower limit of normal. Patients classified as having airflow limitation by fixed ratio only had generally small, nonsignificant increases in the odds of adverse outcomes. Patients having airflow limitation based on both fixed ratio and lower limit of normal had larger, significant increases in odds. But strongest associations were seen for patients who had airflow limitation by both fixed ratio and lower limit of normal and also had a low FEV1, defined as one less than 80% of the predicted value. CONCLUSIONS Our results suggest that use of the fixed ratio alone may lead to misdiagnosis of COPD. A diagnosis established by both a low FEV1/FVC (according to fixed ratio and/or lower limit of normal) and a low FEV1 is strongly associated with clinical outcomes. Guidelines should be reconsidered to require both spirometry abnormalities so as to reduce overdiagnosis of COPD.
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Affiliation(s)
- Wouter van Dijk
- Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Wan Tan
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pei Li
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Best Guo
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Summer Li
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
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Aryal S, Diaz-Guzman E, Mannino DM. Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. Int J Chron Obstruct Pulmon Dis 2014; 9:1145-54. [PMID: 25342899 PMCID: PMC4206206 DOI: 10.2147/copd.s54476] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD), one of the most common chronic diseases and a leading cause of death, has historically been considered a disease of men. However, there has been a rapid increase in the prevalence, morbidity, and mortality of COPD in women over the last two decades. This has largely been attributed to historical increases in tobacco consumption among women. But the influence of sex on COPD is complex and involves several other factors, including differential susceptibility to the effects of tobacco, anatomic, hormonal, and behavioral differences, and differential response to therapy. Interestingly, nonsmokers with COPD are more likely to be women. In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations. Women historically have had lower mortality with COPD, but this is changing as well. There are also differences in how men and women respond to different therapies. Despite the changing face of COPD, care providers continue to harbor a sex bias, leading to underdiagnosis and delayed diagnosis of COPD in women. In this review, we present the current knowledge on the influence of sex on COPD risk factors, epidemiology, diagnosis, comorbidities, treatment, and outcomes, and how this knowledge may be applied to improve clinical practices and advance research.
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Affiliation(s)
- Shambhu Aryal
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, USA
| | - Enrique Diaz-Guzman
- Division of Pulmonary, Allergy and Critical Care, University of Alabama, Birmingham, AL, USA
| | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
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Kobayashi S, Yanai M, Hanagama M, Yamanda S. Burden of chronic obstructive pulmonary disease in the elderly population. Respir Investig 2014; 52:296-301. [PMID: 25169845 DOI: 10.1016/j.resinv.2014.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/18/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease and an important health care problem in older adults. The impact of age and specific geriatric issues on COPD in elderly patients has not been well established. METHODS A cross-sectional study of elderly COPD patients was conducted in Japan by using a regional COPD registry database. We compared indices of disease severity (pulmonary function, exercise tolerance, quality of life, and frequency of exacerbations), presence of comorbidities, geriatric conditions (cognitive function, mental status, and activities of daily living [ADL]), and adherence to prescribed drug regimens between elderly and younger patients with COPD. RESULTS In total, 279 patients with stable COPD (median age, 74 years) were identified; 86% of these patients were elderly (65 years of age or older). Elderly COPD patients, especially those who were 75 years of age or older, had significantly more cases of dyspnea, lower exercise tolerance, and poorer ADL and a higher incidence of severe exacerbations than younger patients (all P<0.05). In addition, the prevalence of comorbidities, including cardiovascular disease and cancer, was significantly higher in elderly COPD patients. Elderly COPD patients had specific geriatric conditions, including cognitive impairment. Adherence to inhaled drug regimens in elderly patients was as favorable as that in younger patients. CONCLUSIONS Age and specific geriatric conditions have a great negative impact on COPD in elderly patients. Geriatric conditions should be addressed in the management of elderly COPD patients.
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Affiliation(s)
- Seiichi Kobayashi
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki 986-8522, Japan.
| | - Masaru Yanai
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki 986-8522, Japan.
| | - Masakazu Hanagama
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki 986-8522, Japan.
| | - Shinsuke Yamanda
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki 986-8522, Japan.
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Lamprecht B, Mahringer A, Soriano JB, Kaiser B, Buist AS, Studnicka M. Is spirometry properly used to diagnose COPD? Results from the BOLD study in Salzburg, Austria: a population-based analytical study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:195-200. [PMID: 23538703 PMCID: PMC6442781 DOI: 10.4104/pcrj.2013.00032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Current guidelines recommend spirometry to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). Aims: To investigate whether a self-reported diagnosis of COPD is associated with prior spirometry and whether a correct diagnosis of COPD is more likely when spirometry was performed. Methods: We used data from the population-based Austrian Burden of Obstructive Lung Disease (BOLD) study. Participants were aged >40 years and completed post-bronchodilator spirometry. Reported COPD diagnosis and reported prior lung function test were based on questionnaire. Persistent airflow limitation was defined as post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio <0.7, corresponding with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) grade I+, and GOLD grade II+ was also investigated. A correct diagnosis of COPD was defined as a reported physician's diagnosis of COPD and the presence of persistent airflow limitation. Results: 68 (5.4%) of 1,258 participants reported a prior physician's diagnosis of COPD. Of these, only 17 (25.0%) reported a lung function test within the past 12 months and 46 (67.6%) at any time in the past. The likelihood for a correct COPD GOLD grade I+ diagnosis was similar among subjects reporting a lung function test during the last 12 months (likelihood ratio 2.07, 95% CI 0.89 to 5.50) and those not reporting a lung function during the last 12 months (likelihood ratio 2.78, 95% CI 1.58 to 4.87). Similar likelihood ratios were seen when GOLD grade II+ was investigated and when lung function was reported at any time in the past. Conclusions: One-third of subjects with a reported diagnosis of COPD never had a lung function test. When spirometry was reported, this did not increase the likelihood of a correct COPD diagnosis.
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Affiliation(s)
- Bernd Lamprecht
- Department of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria.
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Sieminska A, Jassem E. The many faces of tobacco use among women. Med Sci Monit 2014; 20:153-62. [PMID: 24487778 PMCID: PMC3915001 DOI: 10.12659/msm.889796] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/21/2013] [Indexed: 12/14/2022] Open
Abstract
Smoking is still considered to be mainly a male problem. However, it is estimated that there are approximately 250 million women worldwide who smoke cigarettes and millions more women who use smokeless tobacco products. This article addresses the many facets of tobacco use among women. The aim of the paper is to increase recognition among clinicians and researchers of the specific characteristics of female tobacco use. Together with providing epidemiological data on the distribution of tobacco use among women and data from population-based analyses on sociocultural factors that influence it, the article presents tobacco use during pregnancy as a particularly important public health problem. Further, the article points out sex-related differences (ie, physiological, psychological, or behavioral) between male and female tobacco use. A special focus is on the important role of ovarian hormones. Adverse effects of tobacco use to women and their children as well as tobacco-related morbidities and comorbidities are presented, and women's greater susceptibility to tobacco constituents as compared to men is stressed. Awareness of these differences can contribute to improvement of the effectiveness of smoking cessation programs addressed both to the specific female population and to an individual smoking woman.
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Daldoul H, Denguezli M, Jithoo A, Gnatiuc L, Buist S, Burney P, Tabka Z, Harrabi I. Prevalence of COPD and tobacco smoking in Tunisia--results from the BOLD study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:7257-71. [PMID: 24351745 PMCID: PMC3881165 DOI: 10.3390/ijerph10127257] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 12/11/2022]
Abstract
In Tunisia, there is a paucity of population-based data on Chronic Obstructive Pulmonary Disease (COPD) prevalence. To address this problem, we estimated the prevalence of COPD following the Burden of Lung Disease Initiative. We surveyed 807 adults aged 40+ years and have collected information on respiratory history and symptoms, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Six hundred and sixty one (661) subjects were included in the final analysis. The prevalence of GOLD Stage I and II or higher COPD were 7.8% and 4.2%, respectively (Lower Limit of Normal modified stage I and II or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was more common in subjects aged 70+ years and in those with a BMI < 20 kg/m2. Prevalence of stage I+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. In subjects with COPD, age is a much more powerful predictor of lung function than smoking.
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Affiliation(s)
- Hager Daldoul
- Laboratory of Physiology, Faculty of Medicine Ibn El Jazzar, Mohamed Karoui Avenue, Sousse 4000, Tunisia; E-Mails: (H.D.); (Z.T.)
| | - Meriam Denguezli
- Laboratory of Physiology, Faculty of Medicine Ibn El Jazzar, Mohamed Karoui Avenue, Sousse 4000, Tunisia; E-Mails: (H.D.); (Z.T.)
| | - Anamika Jithoo
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1 Manresa Road, London, SW3 6LR, UK; E-Mails: (A.J.); (L.G.); (P.B.)
| | - Louisa Gnatiuc
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1 Manresa Road, London, SW3 6LR, UK; E-Mails: (A.J.); (L.G.); (P.B.)
| | - Sonia Buist
- Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR 97239, USA; E-Mail:
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1 Manresa Road, London, SW3 6LR, UK; E-Mails: (A.J.); (L.G.); (P.B.)
| | - Zouhair Tabka
- Laboratory of Physiology, Faculty of Medicine Ibn El Jazzar, Mohamed Karoui Avenue, Sousse 4000, Tunisia; E-Mails: (H.D.); (Z.T.)
| | - Imed Harrabi
- Department of Epidemiology, University Hospital Farhat Hached, Sousse 4000, Tunisia; E-Mail:
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Arslan Z, Ilgazlı A, Etiler N, Hamzaoğlu O. Prevalence of chronic obstructive pulmonary disease in kocaeli: an industrialised city in Turkey. Balkan Med J 2013; 30:387-93. [PMID: 25207146 PMCID: PMC4115957 DOI: 10.5152/balkanmedj.2013.8042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 06/26/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an important cause of mortality worldwide. AIMS The aim of this study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in residents who were ≥40 years old and living in a heavily industrialised city of Turkey, Kocaeli, using the Burden of Obstructive Lung Disease Initiative questionnaire. STUDY DESIGN Cross-sectional study. METHODS 1035 residents ≥40 years old and living in Kocaeli were surveyed. Spirometry and the basic BOLD questionnaire was performed. RESULTS 946 subjects entered into the analysis. The prevalence of stage I or higher COPD was 13.3% (8.7% for women and 16.5% for men), the prevalence of COPD at GOLD stage II or higher was 7.1% (4.1% for women and 9.2% for men). We also noted a high prevalence of COPD in never-smokers. CONCLUSION Besides cigarette smoking, occupational exposure to fumes, chemicals and dusts might have also contributed to the high prevalence of COPD noted in residents who were ≥40 years old and living in Kocaeli, Turkey.
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Affiliation(s)
- Zeliha Arslan
- Department of Chest Diseases, Kocaeli University Medical School, Kocaeli, Turkey
| | - Ahmet Ilgazlı
- Department of Chest Diseases, Kocaeli University Medical School, Kocaeli, Turkey
| | - Nilay Etiler
- Department of Public Health, Kocaeli University Medical School, Kocaeli, Turkey
| | - Onur Hamzaoğlu
- Department of Public Health, Kocaeli University Medical School, Kocaeli, Turkey
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Weiss G, Steinacher I, Lamprecht B, Schirnhofer L, Kaiser B, Sönnichsen A, Studnicka M. Detection of chronic obstructive pulmonary disease in primary care in Salzburg, Austria: findings from the real world. ACTA ACUST UNITED AC 2013; 87:136-43. [PMID: 24296512 DOI: 10.1159/000354796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed. OBJECTIVES To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting. METHODS The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥ 40 years. Nonreversible airway obstruction was considered when PBD FEV1/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations. RESULTS 60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV1/FVC <0.7 and FEV1 <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%). CONCLUSION COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.
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Aryal S, Diaz-Guzman E, Mannino DM. COPD and gender differences: an update. Transl Res 2013; 162:208-18. [PMID: 23684710 DOI: 10.1016/j.trsl.2013.04.003] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 01/31/2023]
Abstract
Chronic obstructive lung disease (COPD) is one of the most prevalent health conditions, and a major cause of morbidity and mortality around the globe. Once thought of primarily as a disease of men, COPD is now known to be increasingly prevalent among women. Although increasing tobacco consumption among women during the past several decades might explain some of this increase, the relationship may be more complex, including factors such as differential susceptibility to tobacco, anatomic and hormonal differences, behavioral differences, and differences in response to available therapeutic modalities. Moreover, women with COPD may present differently, may have a different pattern of comorbidities, and may have a better survival after acute exacerbations. Care providers continue to have a gender bias that may affect both diagnosis and treatment. Future work should focus on factors that lead to gender differences in COPD as well as gender-specific treatment strategies.
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Affiliation(s)
- Shambhu Aryal
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY
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van Dijk WD, Gupta N, Tan WC, Bourbeau J. Clinical relevance of diagnosing COPD by fixed ratio or lower limit of normal: a systematic review. COPD 2013; 11:113-20. [PMID: 23862613 DOI: 10.3109/15412555.2013.781996] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Different spirometric criteria in diagnosing COPD have been advocated by different groups, debilitating adequate diagnosis and treatment of COPD. We reviewed the clinical relevance of fixed ratio and lower limit of normal (LLN) in diagnosing COPD and explored if modifying factors may affect their clinical relevance. METHODS Two reviewers independently searched PubMed and Embase for papers that compared both criteria on any clinically relevant outcome, published before June 1st, 2012, without any language restriction. Two reviewers independently extracted the study characteristics, including study design, population characteristics and diagnostic criteria used, and summarized the results of clinical relevance. Study quality was assessed by scoring forms for bias and level of evidence. RESULTS Of 394 studies retrieved, 11 studies were included, with a median of 1,258 participants. Although both criteria appeared related with various clinically relevant outcomes, we were unable to prefer one criterion over the other, with various performances of the criteria for different outcomes. Should the criteria disagree on diagnosis, an alternative diagnosis should be suspected, in particular in those (elderly) with less severe airflow limitation for whom the LLN appears a better criterion. The fixed ratio appears to perform better in subjects with more severe airflow limitation. CONCLUSION In diagnosing COPD, severity of airflow limitation appears an important factor for choosing whether the fixed ratio or LLN. Disagreement between the criteria is suggestive for an alternative diagnosis. Future studies on clinical relevance should further reveal the criterion of choice, in order to improve adequate diagnosis and consequent treatments.
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Affiliation(s)
- Wouter D van Dijk
- 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre , Nijmegen , the Netherlands
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El Hasnaoui A, Rashid N, Lahlou A, Salhi H, Doble A, Nejjari C. Chronic obstructive pulmonary disease in the adult population within the Middle East and North Africa region: rationale and design of the BREATHE study. Respir Med 2013; 106 Suppl 2:S3-15. [PMID: 23290702 DOI: 10.1016/s0954-6111(12)70010-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of the BREATHE study was to estimate the regional prevalence of chronic obstructive pulmonary disease (COPD) symptoms within the general population in the Middle East/North Africa (MENA) region and to document risk factors, disease characteristics and management using a standardised methodology. This was an observational population-based survey performed in ten countries in the Middle East and North Africa (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan. A general population sample of 10,000 subjects ≥ 40 years of age in each country or zone was generated from random telephone numbers. Structured interviews were proposed by telephone. A screening questionnaire was administered to each subject collecting information on respiratory symptoms and smoking habits. Subjects with chronic bronchitis or breathlessness and smoking ≥ 10 pack · years fulfilled the epidemiological definition of COPD ("COPD" population). This population then completed a full disease questionnaire, the COPD Assessment Test (CAT) and a cost-of-disease questionnaire. A randomly selected sample was also assessed by spirometry. In all, 457,258 telephone numbers were generated and contact was established with 210,121 subjects, of whom 65,154 were eligible and 62,086 accepted to participate. The overall response rate was 74.2%. 2,187 (3.5%) subjects fulfilled the criteria for the "COPD" population. Evaluable spirometry data were obtained from 1,847 (14.2%) subjects to whom it was proposed. The BREATHE study has collected a large amount of information on COPD variables from a representative sample of the general population of countries in the MENA region, which can be compared with other regional COPD initiatives.
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Bárbara C, Rodrigues F, Dias H, Cardoso J, Almeida J, Matos M, Simão P, Santos M, Ferreira J, Gaspar M, Gnatiuc L, Burney P. Prevalência da doença pulmonar obstrutiva crónica em Lisboa, Portugal: estudo Burden of Obstructive Lung Disease. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:96-105. [DOI: 10.1016/j.rppneu.2012.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 11/02/2012] [Accepted: 11/07/2012] [Indexed: 10/26/2022] Open
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Lee CH, Lee MC, Shu CC, Lim CS, Wang JY, Lee LN, Chao KM. Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan: a nationwide cohort study. BMC Infect Dis 2013; 13:194. [PMID: 23631563 PMCID: PMC3652752 DOI: 10.1186/1471-2334-13-194] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear. METHODS We selected COPD cases by using six diagnostic scenarios and control subjects from a nationwide health insurance database, and applied time-dependent Cox regression analysis to identify the risk factors for TB. RESULTS Among 1,000,000 beneficiaries, 23,594 COPD cases and 47,188 non-COPD control subjects were selected. Cox regression analysis revealed that age, male gender, diabetes mellitus, end-stage renal disease, and cirrhosis, as well as COPD (hazard ratio = 2.468 [2.205-2.762]) were independent risk factors for TB. Among the COPD cases, those who developed TB received more oral corticosteroids and oral β-agonists. Time-dependent Cox regression analysis revealed that age, male gender, diabetes mellitus, low income, oral corticosteroid dose, and oral β-agonist dose, but not ICS dose, were independent risk factors for TB. The identified risk factors and their hazard ratios were similar among the COPD cases selected using different scenarios. CONCLUSION Keeping a high suspicion and regularly monitoring for the development of pulmonary TB in COPD patients are necessary, especially for those receiving higher doses of oral corticosteroids and other COPD medications. Although ICS therapy has been shown to predispose COPD patients to pneumonia in large randomized clinical trials, it does not increase the risk of TB in real world practice.
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Affiliation(s)
- Chih-Hsin Lee
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No. 1, Roosevelt Road, Sec. 4, Taipei 10617, Taiwan
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Abstract
Obesity is generally accepted as a global epidemic and the most common metabolic disorder in the world. Obesity affects every organ system but the consequences on the respiratory system are often underappreciated. While the respiratory consequences of being overweight are predominantly mechanical, an inflammatory element has also been proposed. For this discussion, the components of the respiratory system can be divided into the airways, pulmonary parenchyma, pulmonary vasculature, and the upper respiratory tract. This section will discuss respiratory physiology and the mechanisms leading to breathing difficulties in obesity followed by the impact of obesity on commonly occurring pulmonary disorders.
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Al Ghobain M. The prevalence of chronic obstructive pulmonary disease in Saudi Arabia: Where do we stand? Ann Thorac Med 2012; 6:185-6. [PMID: 21977061 PMCID: PMC3183633 DOI: 10.4103/1817-1737.84770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mohammed Al Ghobain
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Vanfleteren LEGW, Franssen FME, Wesseling G, Wouters EFM. The prevalence of chronic obstructive pulmonary disease in Maastricht, the Netherlands. Respir Med 2012; 106:871-4. [PMID: 22349067 DOI: 10.1016/j.rmed.2012.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/23/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an increasing public health problem worldwide. Although epidemiologic data on COPD are important to raise awareness of the burden of disease, there are no actual spirometry-based data on the prevalence of COPD in the Netherlands. METHODS Using the Burden of Obstructive Lung Disease (BOLD) protocol and study design, a population-based sample of adults, aged ≥ 40 years, in the area of Maastricht, the Netherlands was surveyed. Post-bronchodilator spirometry and questionnaires with information on smoking history and reported respiratory disease were collected. COPD was defined as post-bronchodilator FEV(1)/FVC ratio < 0,7 (GOLD) or < the lower limit of normal (LLN) (95th percentile) of the population distribution for FEV(1)/FVC. Data were statistically weighted for the total number of people in the Maastricht population. RESULTS Overall prevalence of COPD was 24%, and was higher for men (28.5%) than for women (195%). (unweighted p = 0.002) The prevalence of GOLD stage 2 or higher COPD was 10%. The prevalence of LLN-defined COPD was 19% and 10% for stage 2 or higher. Overall prevalence of current smoking was 23%. The prevalence of COPD increased with age and amount of pack-years, although 14% of never smokers fulfilled spirometric criteria for COPD. The prevalence of doctor-diagnosed COPD was only 8.8%. CONCLUSION Almost one quarter of the Maastricht population aged ≥ 40 years had COPD. Considering the ageing population and still an important smoking prevalence, this burden is bound to increase and imposes great demands to public health care and society in the Netherlands.
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Affiliation(s)
- Lowie E G W Vanfleteren
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
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