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Garin N, Zarate-Tamames B, Jornet S, García EM, López-Gil MDM, Romero G, Del Estal J. Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00026-6. [PMID: 38580504 DOI: 10.1016/j.farma.2024.02.006] [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: 04/26/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction. RESULTS In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF. CONCLUSIONS Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.
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Affiliation(s)
- Noé Garin
- Servicio de Farmacia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025, España.
| | - Borja Zarate-Tamames
- Servicio de Farmacia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025, España
| | - Sonia Jornet
- Servicio de Farmacia, Hospital Universitari Joan XXIII, Tarragona, España
| | - Eva María García
- Servicio de Farmacia, Hospital Universitario de Fuenlabrada, Fuenlabrada, España
| | | | - Gregorio Romero
- Servicio de Farmacia, Hospital de Hellin, Gerencia de Atención Integrada Hellín, Hellín, España
| | - Jorge Del Estal
- Servicio de Farmacia, Consorci Sanitari Parc Taulí, Sabadell, España
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David SV, Gibson D, Villasante-Tezanos A, Alzweri L, Hernández-Pérez JG, Torres-Sánchez LE, Baillargeon J, Lopez DS. Association of serum testosterone with chronic obstructive pulmonary disease (COPD) in a nationally representative sample of White, Black, and Hispanic men. Hormones (Athens) 2024; 23:153-162. [PMID: 38064143 PMCID: PMC10922908 DOI: 10.1007/s42000-023-00506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/07/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The association between total testosterone (T) and chronic obstructive pulmonary disease (COPD), remains poorly understood. We aim to investigate this association and how it varies by smoking status, body fatness, and race/ethnicity in a nationally representative sample of American men. METHODS Data included a full sample (NHANES 1988-1991, 1999-2004, 2011-2012) and subset sample (excluding 2011-2012, no estradiol and SHBG levels available) of 2748 and 906 men (≥20 years), respectively. COPD was measured by self-report or spirometry test. Total T (ng/mL) was measured among men who participated in a morning examination session. Weighted multivariable-adjusted logistic regression models were conducted. RESULTS Low T was positively associated with self-reported COPD in the full sample (OR = 2.10, 95% CI = 1.18-3.74, Ptrend = 0.010), and when stratified by current smokers and body fatness. When examined across race and ethnicity strata, this association persisted among White men (OR = 2.50, 95% CI = 1.30-4.79, Ptrend = 0.002) but not among Hispanic or Black men. In the subset sample, low T was positively associated with self-reported COPD (OR = 1.42, 95% CI, 0.57,3.55, Ptrend = 0.04), including among smokers and White men, but not body fatness. No significant associations were observed with COPD defined with spirometry plus self-report. CONCLUSION Low levels of T were associated with an increased prevalence of self-reported COPD in the full and subset samples. Similar associations were observed after stratifying by smoking status, body fatness, and race/ethnicity in the full sample and subset sample. Prospective studies are warranted to confirm these significant associations among understudied and underserved populations.
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Affiliation(s)
- Samuel V David
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA.
| | - Derrick Gibson
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA
| | - Alejandro Villasante-Tezanos
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA
| | - Laith Alzweri
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Jacques Baillargeon
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA
| | - David S Lopez
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA.
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James BD, Greening NJ, Tracey N, Haldar P, Woltmann G, Free RC, Steiner MC, Evans RA, Ward TJ. Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD. Respir Med 2024; 222:107525. [PMID: 38182000 DOI: 10.1016/j.rmed.2023.107525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
RATIONALE As the prevalence of multimorbidity increases, understanding the impact of isolated comorbidities in people COPD becomes increasingly challenging. A simplified model of common comorbidity patterns may improve outcome prediction and allow targeted therapy. OBJECTIVES To assess whether comorbidity phenotypes derived from routinely collected clinical data in people with COPD show differences in risk of hospitalisation and mortality. METHODS Twelve clinical measures related to common comorbidities were collected during annual reviews for people with advanced COPD and k-means cluster analysis performed. Cox proportional hazards with adjustment for covariates was used to determine hospitalisation and mortality risk between clusters. MEASUREMENTS AND MAIN RESULTS In 203 participants (age 66 ± 9 years, 60 % male, FEV1%predicted 31 ± 10 %) no comorbidity in isolation was predictive of worse admission or mortality risk. Four clusters were described: cluster A (cardiometabolic and anaemia), cluster B (malnourished and low mood), cluster C (obese, metabolic and mood disturbance) and cluster D (less comorbid). FEV1%predicted did not significantly differ between clusters. Mortality risk was higher in cluster A (HR 3.73 [95%CI 1.09-12.82] p = 0.036) and B (HR 3.91 [95%CI 1.17-13.14] p = 0.027) compared to cluster D. Time to admission was highest in cluster A (HR 2.01 [95%CI 1.11-3.63] p = 0.020). Cluster C was not associated with increased risk of mortality or hospitalisation. CONCLUSIONS Despite presence of advanced COPD, we report striking differences in prognosis for both mortality and hospital admissions for different co-morbidity phenotypes. Objectively assessing the multi-system nature of COPD could lead to improved prognostication and targeted therapy for patients.
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Affiliation(s)
- Benjamin D James
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil J Greening
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Nicole Tracey
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Pranabashis Haldar
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Gerrit Woltmann
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Robert C Free
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; School of Computing and Mathematical Sciences, University of Leicester, Leicester, UK
| | - Michael C Steiner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Thomas Jc Ward
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK.
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Kotlyarov S. The Role of Smoking in the Mechanisms of Development of Chronic Obstructive Pulmonary Disease and Atherosclerosis. Int J Mol Sci 2023; 24:ijms24108725. [PMID: 37240069 DOI: 10.3390/ijms24108725] [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: 04/16/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Tobacco smoking is a major cause of chronic obstructive pulmonary disease (COPD) and atherosclerotic cardiovascular disease (ASCVD). These diseases share common pathogenesis and significantly influence each other's clinical presentation and prognosis. There is increasing evidence that the mechanisms underlying the comorbidity of COPD and ASCVD are complex and multifactorial. Smoking-induced systemic inflammation, impaired endothelial function and oxidative stress may contribute to the development and progression of both diseases. The components present in tobacco smoke can have adverse effects on various cellular functions, including macrophages and endothelial cells. Smoking may also affect the innate immune system, impair apoptosis, and promote oxidative stress in the respiratory and vascular systems. The purpose of this review is to discuss the importance of smoking in the mechanisms underlying the comorbid course of COPD and ASCVD.
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Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
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Mascalchi M, Romei C, Marzi C, Diciotti S, Picozzi G, Pistelli F, Zappa M, Paci E, Carozzi F, Gorini G, Falaschi F, Deliperi AL, Camiciottoli G, Carrozzi L, Puliti D. Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial. Eur Radiol 2023; 33:3115-3123. [PMID: 36854875 PMCID: PMC10121526 DOI: 10.1007/s00330-023-09504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality. METHODS In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach. RESULTS Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality. CONCLUSIONS Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile. KEY POINTS • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy.
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy.
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Chiara Romei
- Division of Radiology, Cisanello Hospital, Pisa, Italy
| | - Chiara Marzi
- "Nello Carrara" Institute of Applied Physics, National Research Council of Italy, Sesto Fiorentino, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Francesca Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | | | | | - Gianna Camiciottoli
- Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
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Mansourian M, Ghasemi K, Haghdoost A, Kopec JA, Sarrafzadegan N, Islam SMS. Measuring the burden of comorbidity for ischaemic heart disease and four common non-communicable diseases in Iran, 1990-2017: a modelling study based on global burden of diseases data. BMJ Open 2022; 12:e054441. [PMID: 36396302 PMCID: PMC9677042 DOI: 10.1136/bmjopen-2021-054441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This modelling study aimed to estimate the comorbidity burden for four common non-communicable diseases with ischaemic heart diseases (IHD) in Iran during a period of 28 years. DESIGN Analysis of the burden of comorbidity with IHD based on data included prevalence rates and the disability weight (DW) average for calculating years lived with disability (YLDs) from the Iran population based on the Global Burden of Disease (GBD) study. SETTING Population-based available data in GBD 2017 study of Iran population. PARTICIPANT The source of data was the GBD 2017 Study. We evaluated IHD, major depressive disorder (MDD), diabetes mellitus (DM), ischaemic stroke (IS), and osteoarthritis (OA) age-standardised prevalence rates and their DW. MAIN OUTCOME MEASURES A new formula that modified the GBD calculator was used to measure the comorbidity YLDs. In the new formula, some multipliers were considered, measuring the departure from independence. RESULT The contribution of total comorbidity for each combination of IHD with DM, MDD, IS and OA was 2.5%, 2.0%, 1.6% and 2.9%, respectively. The highest YLD rates were observed for IHD_MDD, 16.5 in 1990 and 17.0 in 2017. This was followed by IHD_DM, from 11.5 to 16.9 per 100 000. The YLD rates for IHD_OA changed slightly (6.5-6.7) per 100 000, whereas there was a gradual reduction in the trends of IHD-IS, from 4.0-4.5 per 100 000. CONCLUSION Of the four comorbidities studied, the highest burden was due to the coexistence of MDD with IHD. Our results highlight the importance of addressing the burden of comorbidities when studying the burden of IHD or any other non-communicable disease.
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Affiliation(s)
- Marjan Mansourian
- Barcelona Tech (UPC), Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Khojasteh Ghasemi
- Cardiovascular Research Institute, Interventional Cardiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - AliAkbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran (the Islamic Republic of)
| | - Jacek A Kopec
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nizal Sarrafzadegan
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
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Santos NCD, Miravitlles M, Camelier AA, Almeida VDCD, Maciel RRBT, Camelier FWR. PREVALENCE AND IMPACT OF COMORBIDITIES IN INDIVIDUALS WITH COPD: A SYSTEMATIC REVIEW. Tuberc Respir Dis (Seoul) 2022; 85:205-220. [PMID: 35618259 PMCID: PMC9263346 DOI: 10.4046/trd.2021.0179] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to describe the prevalence of comorbidities associated with chronic obstructive pulmonary disease (COPD) and their relation with relevant outcomes. A systematic review based on the PRISMA methodology was performed from January 2020 until July 2021. The MEDLINE, Lilacs, and Scielo databases were searched to identify studies related to COPD and its comorbidities. Observational studies on the prevalence of comorbidities in COPD patients and costs with health estimates, reduced quality of life, and mortality were included. Studies that were restricted to one or more COPD pain assessments and only specific comorbidities such as osteoporosis, bronchitis, and asthma were excluded. The initial search identified 1,409 studies and after applying the inclusion and exclusion criteria, 20 studies were finally selected for analysis (comprising data from 447,459 COPD subjects). The most frequent COPD comorbidities were: hypertension (range, 17%–64.7%), coronary artery disease (19.9%–47.8%), diabetes (10.2%–45%), osteoarthritis (18%–43.8%), psychiatric conditions (12.1%–33%), and asthma (14.7%–32.5%). Several comorbidities had an impact on the frequency and severity of COPD exacerbations, quality of life, and mortality risk, in particular malignancies, coronary artery disease, chronic heart failure, and cardiac arrhythmias. Comorbidities, especially cardiovascular diseases and diabetes, are frequent in COPD patients, and some of them are associated with higher mortality.
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Shnoda M, Gajjar K, Ivanova V. COPD and Cardiovascular Disease: A Review of Association, Interrelationship, and Basic Principles for Integrated Management. Crit Care Nurs Q 2021; 44:91-102. [PMID: 33234862 DOI: 10.1097/cnq.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of comorbid cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD) can result in unfavorable outcomes, ranging from deterioration in quality of life to increases in all-cause and cardiovascular mortality. Moreover, cardiovascular events are major cause of hospitalization in patients with COPD and contributing significantly to the economic burden of the disease. Despite the acknowledgment of the prognostic significance of CVD comorbidity in COPD patients, CVD remains underrecognized and undertreated in this patient population. In this article, we address the current knowledge about the estimated prevalence, pathophysiologic association, as well as important considerations in the diagnosis and management of CVD in COPD patients.
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Affiliation(s)
- Mina Shnoda
- Divisions of Internal Medicine (Dr Shnoda) and Cardiovascular Institute (Drs Gajjar and Ivanova), Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
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Omori H, Higashi N, Nawa T, Fukui T, Kaise T, Suzuki T. Associated Factors and Comorbidities of Airflow Limitation in Subjects Undergoing Comprehensive Health Examination in Japan - Survey of Chronic Obstructive Pulmonary Disease Patients Epidemiology in Japan (SCOPE- J). Int J Chron Obstruct Pulmon Dis 2020; 15:3039-3050. [PMID: 33262583 PMCID: PMC7696619 DOI: 10.2147/copd.s272588] [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: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify associated factors of having at least one of the airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases in health examinees, and to describe the characteristics of each subgroup classified by comorbidities. Subjects and Methods This was an observational cross-sectional survey carried out in multiple regions of Japan. Subjects aged 40 years older, undergoing comprehensive health examination, were recruited. Airflow limitation was defined as having forced expiratory volume in 1 s/forced vital capacity lower than 70%. Associated factors of having at least one of the airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases were examined by logistic regression analysis. Subgroup classification by comorbidity patterns was conducted by hierarchical cluster analysis. Results In a total of 22,293 subjects, 1520 (6.8%) had at least one of the airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases. With this objective variable, the following explanatory variables were significantly associated: older age, higher total score in the chronic obstructive pulmonary disease assessment test (CAT) and coexistence of lung cancer (common in ever-smokers and never-smokers), higher pack-years, lower body mass index, higher C-reactive protein, without coexistence of diabetes mellitus (specific in ever-smokers), male sex, coexistence of anxiety, and sleep disorder (specific in never-smokers). Among the 1520 subjects, 1512 subjects with smoking history data were classified by comorbidity patterns into subgroups of "no comorbidities," "mixed comorbidities," "inflammatory comorbidities," "overweight," "underweight," and "chronic kidney disease." "Inflammatory comorbidities" were specific in ever-smokers, and "underweight" was specific in never-smokers. Conclusion Several factors were identified as associated factors of having at least one of airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases and they were different between ever-smokers and never-smokers. Different comorbidity patterns were observed by smoking history. These findings could provide information to assist the management of subjects with COPD or at risk for COPD in the general population.
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Affiliation(s)
- Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noritaka Higashi
- Department of Respiratory Medicine, Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | | | - Toshiki Fukui
- Center for Preventive Medical Treatment, Olive Takamatsu Medical Clinic, Takamatsu, Japan
| | - Toshihiko Kaise
- Japan Development Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Takeo Suzuki
- Japan Development Division, GlaxoSmithKline K.K., Tokyo, Japan
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Vu HM, Nguyen LH, Tran TH, Pham KTH, Phan HT, Nguyen HN, Tran BX, Latkin CA, Ho CS, Ho RC. Effects of Chronic Comorbidities on the Health-Related Quality of Life among Older Patients after Falls in Vietnamese Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193623. [PMID: 31569612 PMCID: PMC6801440 DOI: 10.3390/ijerph16193623] [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] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022]
Abstract
Although comorbidities are prevalent in older people experiencing falls, there is a lack of studies examining their influence on health-related quality of life (HRQOL) in this population. This study examines the prevalence of comorbidities and associations between comorbidities and HRQOL in older patients after falls in Vietnamese hospitals. A cross-sectional design was employed among 405 older patients admitted to seven hospitals due to fall injuries in Thai Binh province, Vietnam. The EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) was used to measure HRQOL. Socio-demographic characteristics were collected using a structured questionnaire, while comorbidities and other clinical characteristics were examined by physicians and extracted from medical records. Multivariate Tobit regression was used to determine the associations between comorbidities and HRQOL. Among 405 patients, 75.6% had comorbidities, of which hypertension and osteoarthritis were the most common. Lumbar spine/cervical spine diseases (Coefficient (Coef.) = −0.10; 95%CI = −0.18; 0.03) and stroke (Coef. = −0.36; 95%CI = −0.61; −0.10) were found to be associated with a significantly decreased EQ-5D index. Participants with three comorbidities had EQ-5D indexes 0.20 points lower (Coef. = −0.20; 95%CI = −0.31; −0.09) in comparison with those without comorbidities. This study underlined a significantly high proportion of comorbidities in older patients hospitalized due to fall injuries in Vietnam. In addition, the existence of comorbidities was associated with deteriorating HRQOL. Frequent monitoring and screening comorbidities are critical to determining which individuals are most in need of HRQOL enhancement.
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Affiliation(s)
- Hai Minh Vu
- Department of Trauma and Orthopaedic, Thai Binh Medical University Hospital, Thai Binh 410000, Vietnam;
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.H.N.)
| | - Tung Hoang Tran
- Institute of Orthopaedic and Trauma Surgery, Vietnam—Germany Hospital, Hanoi 100000, Vietnam;
| | - Kiet Tuan Huy Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.T.H.P.); (B.X.T.)
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Correspondence: ; Tel.: +84-3-3399-8764
| | - Hieu Ngoc Nguyen
- Centre of Excellence in Artificial Intelligence in Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam;
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.T.H.P.); (B.X.T.)
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Cyrus S.H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Roger C.M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.H.N.)
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
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Liao KM, Kuo LT, Lu HY. Increased risk of peripheral arterial occlusive diseases in patients with chronic obstructive pulmonary disease: a nationwide study in Taiwan. Int J Chron Obstruct Pulmon Dis 2019; 14:1455-1464. [PMID: 31308650 PMCID: PMC6613542 DOI: 10.2147/copd.s202029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is associated with atherosclerosis. Previous studies including limited sample sizes have shown the prevalence of peripheral arterial occlusive disease (PAOD) among COPD patients. We sought to investigate the incidence of PAOD among COPD patients in Taiwan using a national database. Methods COPD patients were collected from the National Health Insurance Research Database of Taiwan from 1996 to 2010. The COPD cohort was propensity score matched according to age, sex, and comorbidities of atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accidents, and chronic liver disease to patients without COPD (the control cohort). We evaluated the incidence of PAOD in COPD patients and the risk of PAOD associated with atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accidents, and chronic liver disease. Results The study included 51,869 COPD patients and 51,869 control patients without COPD. The incidence of PAOD was 1.23-fold higher (95% confidence interval [CI] =1.17–1.29) in the COPD group than in the non-COPD group. Moreover, COPD and atrial fibrillation alone (adjusted hazard ratio (aHR) 2.99; P=0.001), hypertension alone (aHR, 2.05; P<0.001), diabetes alone (aHR, 2.62; P<0.001) and cerebrovascular accidents alone (aHR 2.05; P<0.001), increased the risk of developing PAOD. The significant aHRs increased (from 3.7 to 4.9) when the number of comorbidities increased (from ≥1 to ≥3 comorbidities). Conclusion COPD patients have a higher incidence and an independently higher risk of PAOD than patients without COPD. The risk of PAOD is markedly elevated in COPD patients with more comorbidities.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
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12
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Inhaled corticosteroids and fractures in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2019; 25:165-172. [DOI: 10.1097/mcp.0000000000000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med 2019; 8:jcm8010069. [PMID: 30634565 PMCID: PMC6352261 DOI: 10.3390/jcm8010069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in context of a “cardiopulmonary continuum” rather than being simply attributed to shared risk factors such as cigarette smoking. Overlapping symptoms such as dyspnea or chest pain lead to a worse prognosis due to missed concomitant diagnoses. Moreover, medication is often withheld as a result of unfounded concerns about side effects. Despite the frequent coincidence, current guidelines are still mostly restricted to the management of the individual disease. Future diagnostic and therapeutic strategies should therefore be guided by an integrative perspective as well as a refined phenotyping of disease entities.
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14
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Bitar AN, Syed Sulaiman SA, Ali IAH, Khan I, Khan AH. Osteoporosis among Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analysis of Prevalence, Severity, and Therapeutic Outcomes. J Pharm Bioallied Sci 2019; 11:310-320. [PMID: 31619912 PMCID: PMC6791086 DOI: 10.4103/jpbs.jpbs_126_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) can be associated with systemic inflammatory trademarks and can coexist with other chronic debilitating diseases such as osteoporosis, which is considered among the most serious comorbidities of COPD. In this review, we aimed at finding answers for the following questions and tried to encapsulate the available literature: (1) how prevalent is osteoporosis among patients with COPD? (2) What are severity patterns of osteoporosis in case of COPD? (3) What are the therapeutic outcomes for patients with osteoporotic COPD? The total number of patients with COPD from all studies was 3815, majority of which were male (2658) representing 69.67% of patients. The mean ± standard deviation for percentage of forced expiratory volume in 1s (FEV1%) was 55.43 ± 14.62%, body mass index for almost 91.29% of patients was 24.4 ± 4.45 kg/m2, whereas fat-free mass index (FFMI) was 17 ± 0.93 kg/m2 for 17.66%. The percentage of patients with COPD having osteoporosis varied in the analyzed studies from 14% up to 66.6%. The mean prevalence of reported osteopenia from 14 studies (n = 2107) was 39.91%, whereas for osteoporosis, the mean prevalence was 37.62% for all included studies. Osteoporosis was highly prevalent among patients with COPD. It is reasonable to call for osteoporosis screening in patients with COPD who are above 65 years, in advanced stages, with BMI lower than 21 kg/m2 or with FFMI lower than 16 kg/m2 for males and 15 kg/m2 for females. There is a lack of research investigating severity and treatments of osteoporosis in patients with COPD.
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Affiliation(s)
- Ahmad Naoras Bitar
- Clinical Pharmacy Department, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Clinical Pharmacy Department, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Irfanullah Khan
- Clinical Pharmacy Department, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amer Hayat Khan
- Clinical Pharmacy Department, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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15
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Luehrs RE, Newell JD, Comellas AP, Hoffman EA, Warner K, Croghan A, DuBose LE, Nopoulos P, Magnotta V, Arndt S, Pierce GL, Hoth KF. CT-Measured Lung Air-Trapping is Associated with Higher Carotid Artery Stiffness in Individuals with Chronic Obstructive Pulmonary Disease. J Appl Physiol (1985) 2018; 125:1760-1766. [PMID: 30307820 DOI: 10.1152/japplphysiol.00580.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Early stages of chronic obstructive pulmonary disease (COPD) are characterized by the loss and narrowing of terminal bronchioles in the lung resulting in 'air-trapping,' often occurring before overt emphysema manifests. Individuals with an airway-predominant phenotype of COPD display extensive lung air-trapping and are at greater cardiovascular disease (CVD) risk than COPD patients with an emphysema-predominant phenotype. We hypothesized that the degree of computed tomography (CT)-quantified lung air-trapping would be associated with greater aortic and carotid artery stiffness and lower endothelial function, known biomarkers of CVD risk. Lung air-trapping was associated with greater aortic stiffness (carotid femoral pulse wave velocity, CFPWV) (r=0.60, p=0.007) and carotid β-stiffness (r=0.75, p=0.0001) among adults with (n=10) and without (n=9) a clinical diagnosis of COPD and remained significant after adjusting for blood pressure (BP) and smoking history (pack-years) (carotid β-stiffness r=0.68, p<0.01; CFPWV r=0.53, p=0.03). The association between lung air-trapping and carotid β-stiffness remained significant after additionally adjusting for age and FEV1 (r=0.64, p=0.01). In the COPD group only (n=10), lung air-trapping remained associated with carotid β-stiffness (r=0.82, p=0.05) after adjustment for age, pack-years and FEV1. In contrast, no association was observed between CFPWV and lung air-trapping after adjustment for BP, pack-years, age and FEV1 (r=0.12, p=0.83). Lung air-trapping was not associated with endothelial function (brachial artery flow mediated dilation) in the entire cohort (p=0.80) or in patients with COPD only (p=0.71). These data suggest that carotid artery stiffness may be a mechanism explaining the link between airway- predominant phenotypes of COPD and high CVD risk.
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Affiliation(s)
- Rachel E Luehrs
- Health and Human Physiology, University of Iowa, United States
| | | | | | - Eric A Hoffman
- Radiology, Medicine and Biomedical Engineering, University of Iowa, United States
| | | | | | | | | | | | | | - Gary L Pierce
- Health and Human Physiology, University of Iowa, United States
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16
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Fu PK, Tung YC, Wang CY, Hwang SF, Lin SP, Hsu CY, Chen DR. Early and late do-not-resuscitate (DNR) decisions in patients with terminal COPD: a retrospective study in the last year of life. Int J Chron Obstruct Pulmon Dis 2018; 13:2447-2454. [PMID: 30147310 PMCID: PMC6097512 DOI: 10.2147/copd.s168049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose The unpredictable trajectory of COPD can present challenges for patients when faced with a decision regarding a do-not-resuscitate (DNR) directive. The current retrospective analysis was conducted to investigate factors associated with an early DNR decision (prior to last hospital admission) and differences in care patterns between patients who made DNR directives early vs late. Patients and methods Electronic health records (EHR) were reviewed from 271 patients with terminal COPD who died in a teaching hospital in Taiwan. Clinical parameters, patterns of DNR decisions, and medical utilization were obtained. Those patients who had a DNR directive earlier than their last (terminal) admission were defined as “Early DNR” (EDNR). Results A total of 234 (86.3%) patients died with a DNR directive, however only 30% were EDNR. EDNR was associated with increased age (OR=1.07; 95% CI: 1.02–1.12), increased ER visits (OR=1.22; 95% CI: 1.10–1.37), rapid decline in lung function (OR=3.42; 95% CI: 1.12–10.48), resting heart rate ≥100 (OR=3.02; 95% CI: 1.07–8.51), and right-sided heart failure (OR=2.38; 95% CI: 1.10–5.19). The median time period from a DNR directive to death was 68.5 days in EDNR patients and 5 days in “Late DNR” (LDNR) patients, respectively (P<0.001). EDNR patients died less frequently in the intensive care unit (P<0.001), received less frequent mechanical ventilation (MV; P<0.001), more frequent non-invasive MV (P=0.006), and had a shorter length of hospital stay (P=0.001). Conclusions Most patients with terminal COPD had DNR directives, however only 30% of DNR decisions were made prior to their last (terminal) hospital admission. Further research using these predictive factors obtained from EHR systems is warranted in order to better understand the relationship between the timing associated with DNR directive decision making in patients with terminal COPD.
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Affiliation(s)
- Pin-Kuei Fu
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.,Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biotechnology, Hungkuang University, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sheau-Feng Hwang
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.,Palliative Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shin-Pin Lin
- Computer and Communications Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan,
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17
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Ban WH, Joo H, Lim JU, Kang HH, Moon HS, Lee SH. The relationship between sleep disturbance and health status in patients with COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2049-2055. [PMID: 29988722 PMCID: PMC6029673 DOI: 10.2147/copd.s167678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The detection of insomnia in patients with COPD is assumed to be significantly lower than the actual prevalence. In this study, we investigated the prevalence of insomnia and the relationship between insomnia and health status in patients with COPD using two fairly simple and straightforward questionnaires: COPD assessment test (CAT) and insomnia severity index (ISI). Patients and methods A cross-sectional study was conducted using data from patients undergoing treatment for COPD at St Paul's Hospital, The Catholic University of Korea, between December 2015 and August 2016. Patients were classified into three groups according to the ISI score: a "clinical insomnia" group (ISI≥15), a "subthreshold insomnia" group (ISI 8-15), and a "non-insomnia" group (ISI<8). Clinical parameters including past medical history, pulmonary function tests, and questionnaire data were collected and analyzed. Results A total of 192 patients were recruited, of which 25.0% were found to have clinical insomnia (ISI≥8). Insomnia severity was related to all CAT component items except for cough, and patients with higher CAT scores generally had more severe insomnia. Logistic regression analysis revealed that CAT score was significantly associated with insomnia in these patients (odds ratio, 1.23; 95% CI, 1.13-1.34; p<0.0001). CAT score was also a significant predictor of insomnia (area under receiver operating characteristic curve, 0.779; p<0.001). The optimal predictive cutoff value was a CAT score >14, giving a sensitivity and specificity of 66.7% and 71.5%, respectively. Conclusion CAT score was closely related to insomnia severity in patients with COPD. The use of CAT scores to assess for the presence and severity of insomnia in these patients may allow for better detection and management and improve clinical practice.
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Affiliation(s)
- Woo Ho Ban
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyonsoo Joo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Uk Lim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,
| | - Hwa Sik Moon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,
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18
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Graumam RQ, Pinheiro MM, Nery LE, Castro CHM. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos Int 2018; 29:1457-1468. [PMID: 29564475 DOI: 10.1007/s00198-018-4483-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/07/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below - 2.5 were all associated with higher risk of fracture. INTRODUCTION Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD. METHODS Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients. RESULTS Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078-9.297); p < 0.001), while high plasma iPTH (OR = 1.045 (1.005-1.088); p = 0.029) and low ALM (OR = 0.99965 (0.99933-0.99997); p = 0.031) were predictors of non-vertebral fractures. CONCLUSION Highly prevalent in COPD, osteoporosis and low lean mass were associated with FEV1% < 50%. Age, low lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.
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Affiliation(s)
- R Q Graumam
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - M M Pinheiro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - L E Nery
- Pulmonology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - C H M Castro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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19
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Foitzek N, Ávila CC, Ivandic I, Bitenc Č, Cabello M, Gruber S, Leonardi M, Muñoz-Murillo A, Scaratti C, Tobiasz-Adamczyk B, Vlachou A, Esteban E, Sabariego C, Coenen M. What Persons with Chronic Health Conditions Need to Maintain or Return to Work-Results of an Online-Survey in Seven European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040595. [PMID: 29587433 PMCID: PMC5923637 DOI: 10.3390/ijerph15040595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022]
Abstract
Chronic health conditions represent the major share of the disease burden in Europe and have a significant impact on work. This study aims to: (1) identify factors that have a negative or positive impact on the work lives of persons with chronic health conditions; (2) explore the needs of these persons to maintain a job or return to work and (3) compare these results with respect to these persons' occupational status. An online survey was performed in seven European countries. Open-ended survey questions were analyzed using qualitative methods. In total, 487 participants with six chronic health conditions participated. The majority of participants named work-related aspects (such as career development, stress at the workplace, work structure and schedule as well as workload), support of others and attitudes of others as being the factors positively and negatively impact their work lives the most. Our study shed light on the importance of changing the attitudes of supervisors and co-workers to counteract stigmatization of persons with chronic health conditions in the workplace. In conclusion, this study provides a basis for developing new strategies of integration and reintegration at work for persons with chronic health conditions in European countries.
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Affiliation(s)
- Nicole Foitzek
- Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Carolina C Ávila
- Department of Psychiatry, Universidad Autónoma de Madrid and Institute of Health Carlos III, CIBER of Mental Health (CIBERSAM), 28038 Madrid, Spain.
| | - Ivana Ivandic
- Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Črtomir Bitenc
- Development Center for Vocational Rehabilitation, University Rehabilitation Institute Republic of Slovenia, 1000 Ljubljana, Slovenia.
| | - Maria Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid and Institute of Health Carlos III, CIBER of Mental Health (CIBERSAM), 28038 Madrid, Spain.
| | - Sonja Gruber
- Disability and Diversity Studies, Carinthia University of Applied Science (CUAS), 9020 Klagenfurt, Austria.
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Neurological Institute Carlo Besta IRCCS Foundation, 20133 Milan, Italy.
| | - Amalia Muñoz-Murillo
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Barcelona, Spain.
| | - Chiara Scaratti
- Neurology, Public Health and Disability Unit; Neurological Institute Carlo Besta IRCCS Foundation, 20133 Milan, Italy.
| | - Beata Tobiasz-Adamczyk
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-034 Krakow, Poland.
| | - Anastasia Vlachou
- Department of Special Education, University of Thessaly, 38221 Volos, Greece.
| | - Eva Esteban
- Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Carla Sabariego
- Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Michaela Coenen
- Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
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20
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Barn P, Giles L, Héroux ME, Kosatsky T. A review of the experimental evidence on the toxicokinetics of carbon monoxide: the potential role of pathophysiology among susceptible groups. Environ Health 2018; 17:13. [PMID: 29402286 PMCID: PMC5800074 DOI: 10.1186/s12940-018-0357-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/26/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND Acute high level carbon monoxide (CO) exposure can cause immediate cardio-respiratory arrest in anyone, but the effects of lower level exposures in susceptible persons are less well known. The percentage of CO-bound hemoglobin in blood (carboxyhemoglobin; COHb) is a marker of exposure and potential health outcomes. Indoor air quality guidelines developed by the World Health Organization and Health Canada, among others, are set so that CO exposure does not lead to COHb levels above 2.0%, a target based on experimental evidence on toxicodynamic relationships between COHb and cardiac performance among persons with cardiovascular disease (CVD). The guidelines do not consider the role of pathophysiological influences on toxicokinetic relationships. Physiological deficits that contribute to increased CO uptake, decreased CO elimination, and increased COHb formation can alter relationships between CO exposures and resulting COHb levels, and consequently, the severity of outcomes. Following three fatalities attributed to CO in a long-term care facility (LTCF), we queried whether pathologies other than CVD could alter CO-COHb relationships. Our primary objective was to inform susceptibility-specific modeling that accounts for physiological deficits that may alter CO-COHb relationships, ultimately to better inform CO management in LTCFs. METHODS We reviewed experimental studies investigating relationships between CO, COHb, and outcomes related to health or physiological outcomes among healthy persons, persons with CVD, and six additional physiologically susceptible groups considered relevant to LTCF residents: persons with chronic obstructive pulmonary disease (COPD), anemia, cerebrovascular disease (CBD), heart failure, multiple co-morbidities, and persons of older age (≥ 60 years). RESULTS We identified 54 studies published since 1946. Six studies investigated toxicokinetics among healthy persons, and the remaining investigated toxicodynamics, mainly among healthy persons and persons with CVD. We identified one study each of CO dynamics in persons with COPD, anemia and persons of older age, and no studies of persons with CBD, heart failure, or multiple co-morbidities. Considerable heterogeneity existed for exposure scenarios and outcomes investigated. CONCLUSIONS Limited experimental human evidence on the effects of physiological deficits relevant to CO kinetics exists to support indoor air CO guidelines. Both experimentation and modeling are needed to assess how physiological deficits influence the CO-COHb relationship, particularly at sub-acute exposures relevant to indoor environments. Such evidence would better inform indoor air quality guidelines and CO management in indoor settings where susceptible groups are housed.
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Affiliation(s)
- Prabjit Barn
- National Collaborating Centre for Environmental Health, 200 - 601 West Broadway, Vancouver, BC V5Z 4C2 Canada
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Luisa Giles
- National Collaborating Centre for Environmental Health, 200 - 601 West Broadway, Vancouver, BC V5Z 4C2 Canada
- Currently at: Department of Sport Science, Douglas College, P.O. Box 2503, 700 Royal Avenue, New Westminster, BC V3L 5B2 Canada
| | - Marie-Eve Héroux
- Water and Air Quality Bureau, Health Canada, 269 Laurier Ave West, Ottawa, K1A 0K9 Canada
| | - Tom Kosatsky
- National Collaborating Centre for Environmental Health, 200 - 601 West Broadway, Vancouver, BC V5Z 4C2 Canada
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
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21
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Morgan AD, Zakeri R, Quint JK. Defining the relationship between COPD and CVD: what are the implications for clinical practice? Ther Adv Respir Dis 2018; 12:1753465817750524. [PMID: 29355081 PMCID: PMC5937157 DOI: 10.1177/1753465817750524] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/04/2017] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this population is considerable and the cumulative cost of treating comorbidities may even exceed that of treating COPD itself. Our understanding of the biological mechanisms that link COPD and various forms of CVD has improved significantly over the past decade. But despite broad acceptance of the prognostic significance of CVDs in COPD, there remains widespread under-recognition and undertreatment of comorbid CVD in this population. The reasons for this are unclear; however institutional barriers and a lack of evidence-based guidelines for the management of CVD in people with COPD may be contributory factors. In this review, we summarize current knowledge relating to the prevalence and incidence of CVD in people with COPD and the mechanisms that underlie their coexistence. We discuss the implications for clinical practice and highlight opportunities for improved prevention and treatment of CVD in people with COPD. While we advocate more active assessment for signs of cardiovascular conditions across all age groups and all stages of COPD severity, we suggest targeting those aged under 65 years. Evidence indicates that the increased risks for CVD are particularly pronounced in COPD patients in mid-to-late-middle-age and thus it is in this age group that the benefits of early intervention may prove to be the most effective.
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Affiliation(s)
- Ann D Morgan
- National Heart and Lung Institute, Imperial
College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR,
UK
| | - Rosita Zakeri
- Respiratory Epidemiology, Occupational Medicine
and Public Health, National Heart and Lung Institute, Imperial College
London, London, UK
- Royal Brompton and Harefield NHS Foundation
Trust, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine
and Public Health, National Heart and Lung Institute, Imperial College
London, London, UK
- Faculty of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine, London, UK
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Greulich T, Weist BJ, Koczulla AR, Janciauskiene S, Klemmer A, Lux W, Alter P, Vogelmeier CF. Prevalence of comorbidities in COPD patients by disease severity in a German population. Respir Med 2017; 132:132-138. [DOI: 10.1016/j.rmed.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/25/2017] [Accepted: 10/10/2017] [Indexed: 02/08/2023]
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Nilsson U, Blomberg A, Johansson B, Backman H, Eriksson B, Lindberg A. Ischemic ECG abnormalities are associated with an increased risk for death among subjects with COPD, also among those without known heart disease. Int J Chron Obstruct Pulmon Dis 2017; 12:2507-2514. [PMID: 28860744 PMCID: PMC5573057 DOI: 10.2147/copd.s136404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract presentation An abstract, including parts of the results, has been presented at an oral session at the European Respiratory Society International Conference, London, UK, September 2016. Background Cardiovascular comorbidity contributes to increased mortality among subjects with COPD. However, the prognostic value of ECG abnormalities in COPD has rarely been studied in population-based surveys. Aim To assess the impact of ischemic ECG abnormalities (I-ECG) on mortality among individuals with COPD, compared to subjects with normal lung function (NLF), in a population-based study. Methods During 2002–2004, all subjects with FEV1/VC <0.70 (COPD, n=993) were identified from population-based cohorts, together with age- and sex-matched referents without COPD. Re-examination in 2005 included interview, spirometry, and 12-lead ECG in COPD (n=635) and referents [n=991, whereof 786 had NLF]. All ECGs were Minnesota-coded. Mortality data were collected until December 31, 2010. Results I-ECG was equally common in COPD and NLF. The 5-year cumulative mortality was higher among subjects with I-ECG in both groups (29.6% vs 10.6%, P<0.001 and 17.1% vs 6.6%, P<0.001). COPD, but not NLF, with I-ECG had increased risk for death assessed as the mortality risk ratio [95% confidence interval (CI)] when compared with NLF without I-ECG, 2.36 (1.45–3.85) and 1.65 (0.94–2.90) when adjusted for common confounders. When analyzed separately among the COPD cohort, the increased risk for death associated with I-ECG persisted after adjustment for FEV1 % predicted, 1.89 (1.20–2.99). A majority of those with I-ECG had no previously reported heart disease (74.2% in NLF and 67.3% in COPD) and the pattern was similar among them. Conclusion I-ECG was associated with an increased risk for death in COPD, independent of common confounders and disease severity. I-ECG was of prognostic value also among those without previously known heart disease.
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Affiliation(s)
- Ulf Nilsson
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå
| | - Berne Eriksson
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
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Layton AM, Armstrong HF, Baldwin MR, Podolanczuk AJ, Pieszchata NM, Singer JP, Arcasoy SM, Meza KS, D'Ovidio F, Lederer DJ. Frailty and maximal exercise capacity in adult lung transplant candidates. Respir Med 2017; 131:70-76. [PMID: 28947046 DOI: 10.1016/j.rmed.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frail lung transplant candidates are more likely to be delisted or die without receiving a transplant. Further knowledge of what frailty represents in this population will assist in developing interventions to prevent frailty from developing. We set out to determine whether frail lung transplant candidates have reduced exercise capacity independent of disease severity and diagnosis. METHODS Sixty-eight adult lung transplant candidates underwent cardiopulmonary exercise testing (CPET) and a frailty assessment (Fried's Frailty Phenotype (FFP)). Primary outcomes were peak workload and peak aerobic capacity (V˙O2). We used linear regression to adjust for age, gender, diagnosis, and lung allocation score (LAS). RESULTS The mean ± SD age was 57 ± 11 years, 51% were women, 57% had interstitial lung disease, 32% had chronic obstructive pulmonary disease, 11% had cystic fibrosis, and the mean LAS was 40.2 (range 19.2-94.5). In adjusted models, peak workload decreased by 10 W (95% CI 4.7 to 14.6) and peak V˙O2 decreased by 1.8 mL/kg/min (95% CI 0.6 to 2.9) per 1 unit increment in FFP score. After adjustment, exercise tolerance was 38 W lower (95% CI 18.4 to 58.1) and peak V˙O2 was 8.5 mL/kg/min lower (95% CI 3.3 to 13.7) among frail participants compared to non-frail participants. Frailty accounted for 16% of the variance (R2) of watts and 19% of the variance of V˙O2 in adjusted models. CONCLUSION Frailty contributes to reduced exercise capacity among lung transplant candidates independent of disease severity.
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Affiliation(s)
- Aimee M Layton
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
| | - Hilary F Armstrong
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Matthew R Baldwin
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Anna J Podolanczuk
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Nicole M Pieszchata
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Jonathan P Singer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Frank D'Ovidio
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - David J Lederer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
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25
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Riesco JA, Alcázar B, Trigueros JA, Campuzano A, Pérez J, Lorenzo JL. Active smoking and COPD phenotype: distribution and impact on prognostic factors. Int J Chron Obstruct Pulmon Dis 2017; 12:1989-1999. [PMID: 28740378 PMCID: PMC5505548 DOI: 10.2147/copd.s135344] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype. PATIENTS AND METHODS This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis), and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade), quality of life according to the COPD assessment test (CAT), and presence of comorbidities, according to phenotypic expression. RESULTS In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03). Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype. CONCLUSION Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease.
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Affiliation(s)
- Juan Antonio Riesco
- Pulmonology Department, Hospital San Pedro de Alcántara.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Cáceres
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Figueira Gonçalves JM, Dorta Sánchez R, Rodri Guez Pérez MDC, Viña Manrique P, Díaz Pérez D, Guzmán Saenz C, Palmero Tejera JM, Pérez Rodríguez A, Pérez Negrín L. Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease in the Canary Islands (CCECAN study). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2017; 29:149-156. [PMID: 28390852 DOI: 10.1016/j.arteri.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Numerous studies have shown a high prevalence of cardiovascular disease in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the prevalence of cardiovascular risk factors and comorbidity in a Canary Islands population diagnosed with COPD, and compared it with data from the general population. PATIENTS AND METHODS A cross-sectional study was carried out in 300 patients with COPD and 524 subjects without respiratory disease (control group). The two groups were compared using standard bivariate methods. Logistic regression models were used to estimate the cardiovascular risks in COPD patients compared to control group. RESULTS Patients with COPD showed a high prevalence of hypertension (72%), dyslipidaemia (73%), obesity (41%), diabetes type 2 (39%), and sleep apnoea syndrome (30%) from mild stages of the disease (GOLD 2009). There was a 22% prevalence of cardiac arrhythmia, 16% of ischaemic heart disease, 16% heart failure, 12% peripheral vascular disease, and 8% cerebrovascular disease. Compared to the control group, patients with COPD had a higher risk of dyslipidaemia (OR 3.24, 95% CI; 2.21-4.75), diabetes type 2 (OR 1.52, 95% CI; 1.01-2,28), and ischaemic heart disease (OR 2.34, 95% CI; 1.22-4.49). In the case of dyslipidaemia, an increased risk was obtained when adjusted for age, gender, and consumption of tobacco (OR 5.04, 95% CI; 2.36-10.74). CONCLUSIONS Patients with COPD resident in the Canary Islands have a high prevalence of hypertension, dyslipidaemia, ischaemic heart disease, and cardiac arrhythmia. Compared to general population, patients with COPD have a significant increase in the risk of dyslipidaemia.
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Affiliation(s)
- Juan Marco Figueira Gonçalves
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España.
| | - Rafael Dorta Sánchez
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
| | | | - Pedro Viña Manrique
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
| | - David Díaz Pérez
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
| | - Cristina Guzmán Saenz
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
| | - Juan Manuel Palmero Tejera
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
| | - Alicia Pérez Rodríguez
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
| | - Lorenzo Pérez Negrín
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, España
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